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Assessing relationships between health-related quality of life and adherence to antiretroviral therapy

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Abstract

Objective: To investigate associations between health-related quality of life (HRQoL), as assessed using the multidimensional quality of life-HIV (MQOL-HIV) questionnaire, and adherence to antiretroviral treatment in HIV-infected subjects. Design: Multicentre cross-sectional study in three institutional tertiary hospitals in northwest Spain. Patients and methods: The MQOL-HIV was completed by 235 HIV-infected adults undergoing antiretroviral treatment. Adherence to antiretroviral therapy was assessed by using patient's self-report. Information about sociodemographic characteristics and clinical variables was also collected. Results: Good adherence (≥95% of prescribed pills correctly taken) was reported by 131 patients (55.7%). Univariate analyses indicated that the sociodemographic and clinical variables associated with adherence were age, educational level, income, employment, home stability, transmission route, history of previous antiretroviral therapy, and number of prescribed pills/day. Subscales of MQOL-HIV associated with adherence were mental health, cognitive functioning, financial status, medical care, partner intimacy, and (in men only) sexual functioning. Stepwise logistic regression showed that good adherence was more frequent in patients aged >40 years (odds ratio, OR: 2.50; 95% confidence interval, CI: 1.15–5.61) and in patients with high cognitive functioning (OR: 2.26; 95% CI: 1.19–4.30). Conversely, poor adherence was more frequent in patients without stable home (OR: 2.96; 95% CI: 1.39–6.32), in patients required to take 14 or more pills/day (OR: 2.17; 95% CI: 1.18–4.28), in patients with low financial status (OR: 3.42; 95% CI: 1.57–7.45), and in patients reporting low medical care (OR: 2.07; 95% CI: 1.07–3.98). Conclusions: HRQoL dimensions, notably cognitive functioning, financial status and medical care, are closely associated with antiretroviral therapy adherence.

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References

  1. Pialoux C, Raffi F, Brun-Vezinet F, et al. A randomised trial of three maintenance regimens given after three months of induction therapy with zidovudine, lamivudine, and indinavir in previously untreated HIV-1-infected patients. N Engl J Med 1998; 339: 1269-1276.

    Google Scholar 

  2. Detels R, Muñoz A, McFarlane G, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. JAMA 1998; 280: 1497-1503.

    Google Scholar 

  3. Marschner IC, Collier AC, Coombs RW, et al. Use of changes in plasma levels of human immunodeficiency virus type 1 RNA to assess the clinical benefit of antiretroviral therapy. J Infect Dis 1998; 177: 40-47.

    Google Scholar 

  4. Palella F, Delaney K, Moorman A, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. N Engl J Med 1998; 338: 853-860.

    Google Scholar 

  5. Altice FL, Friedland GH. The era of adherence to HIV therapy. Ann Intern Med 1998; 129: 504-505.

    Google Scholar 

  6. Descamps D, Flandre P, Calvez V, et al. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. Trilege (Agence Nationale de Recherches sur le SIDA 072 Study Team). JAMA 2000; 283: 205-211.

    Google Scholar 

  7. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133: 21-30.

    Google Scholar 

  8. Hecht M, Grant RM, Petropoulos CJ, Dillon B, Chesney MA, Tian H. Sexual transmission of an HIV-1 variant resistant to multiple reverse transcriptase and protease inhibitors. N Engl J Med 1999; 339: 307-311.

    Google Scholar 

  9. Schag CA, Ganz PA, Kahn B, Petersen L. Assessing the needs and quality of life of patients with HIV infection: Development of the HIV overview of problems-evaluation system (HOPES). Qual Life Res 1992; 1: 397-413.

    Google Scholar 

  10. Ganz PA, Schag AC, Kahn B, Petersen L. Assessing the quality of life of HIV infected persons: Clinical and descriptive information from studies with the HOPES. Psycol Health 1994; 9: 93-110.

    Google Scholar 

  11. Cella DF, McCain NL, Peterman AH, Mo F, Wolen D. Development and validation of the functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Qual Life Res 1996; 5: 450-463.

    Google Scholar 

  12. Peterman AH, Cella D, Mo F, McCain N. Psychometric validation of the revised functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Qual Life Res 1997; 6: 572-584.

    Google Scholar 

  13. Wu AW, Rubin HR, Mathews WC, et al. A health status questionnaire using 30 items from the medical outcomes study. Preliminary validation in persons with early HIV infection. Med Care 1991; 29: 786-798.

    Google Scholar 

  14. Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV). Qual Life Res 1997; 6: 481-493.

    Google Scholar 

  15. Smith KW, Avis NE, Mayer KH, Swislow L. Use of the MQoL-HIV with asymptomatic HIV-positive patients. Qual Life Res 1997; 6: 555-560.

    Google Scholar 

  16. Singh N, Berman SM, Swindells S, et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis 1999, 29: 824-830.

    Google Scholar 

  17. Anonymous 1993. Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992; 41: RR-17.

  18. Badia X, Podzamczer D, Garcia M, López-Lavid C, Consiglio E and the Spanish MOS-HIV and MQOL-HIV validation group. A randomized study comparing instruments for measuring health-related quality of life in HIV-infected patients. AIDS 1999; 13: 1727-1735.

    Google Scholar 

  19. Badia X, Podzamczer D, Casado A, Lopez-Lavid C, Garcia M. Evaluating changes in health status in HIV-infected patients: Medical outcomes. Study-HIV and multidimensional quality of life-HIV quality of life questionnaires. Spanish MOS-HIV and MQOL-HIV Validation Group. AIDS 2000; 14: 1439-1447.

    Google Scholar 

  20. Nieuwkerk PT, Gisolf EH, Colebunders R, Wu AW, Danner SA, Sprangers MA. Quality of life in asymptomatic-and symptomatic HIV infected patients in a trial of ritonavir/saquinavir therapy. The Prometheus Study Group. AIDS 2000; 14: 181-187.

    Google Scholar 

  21. Casado A, Consiglio E, Podzamczer D, Badia X. Highly active antiretroviral treatment (HAART) and health-related quality of life in naive and pretreated HIV-infected patients. HIV Clin Trials 2001; 2: 477-483.

    Google Scholar 

  22. Miners AH, Sabin CA, Mocroft A, Youle M, Fisher M, Johnson M. Health-related quality of life in individuals infected with HIV in the era of HAART. HIV Clin Trials 2001; 2: 484-492.

    Google Scholar 

  23. Belloso W, Consiglio E, Lopardo G, et al. Quality of life instrument development in argentinian HIV+ population (preliminary report). The 1st IAS Conference on HIV Pathogenesis and Treatment. Buenos Aires, July 2001 [abstract 92].

  24. Carrieri P, Cailleton V, Le Moing V, et al. The dynamic of adherence to highly active antiretroviral therapy: Results from the French National APROCO Cohort. J Acquir Immune Defic Syndr 2001; 28: 232-239.

    Google Scholar 

  25. Duong M, Piroth L, Peytavin G, et al. Values of patient self-report and plasma human immunodeficiency virus protease inhibitor level as markers of adherence to antiretroviral therapy: Relationship to virologic response. Clin Infect Dis 2001; 33: 386-392.

    Google Scholar 

  26. Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS 2000; 14: 357-366.

    Google Scholar 

  27. Wagner GJ, Rabkin JG. Measuring medication adherence: Are missed doses reported more accurately then perfect adherence? AIDS Care 2000; 12: 405-408.

    Google Scholar 

  28. Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999; 13: 1763-1769.

    Google Scholar 

  29. McNabb J, Ross JW, Abriola K, Turley C, Nightingale CH, Nicolau DP. Adherence to highly active antiretroviral therapy predicts virologic outcome at an inner-city human immunodeficiency virus clinic. Clin Infect Dis 2001; 33: 700-705.

    Google Scholar 

  30. Gazzard B, Moyle G. 1998 revision to the British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals. BHIVA Guidelines Writing Committee. Lancet 1998; 352: 314-316.

    Google Scholar 

  31. Carpenter CC, Cooper DA, Fischl MA, et al. Antiretroviral therapy in adults: Updated recommendations of the International AIDS Society-USA Panel. JAMA 2000; 283: 381-390.

    Google Scholar 

  32. Miro JM, Antela A, Arrizabalaga J, et al. Recommendation of GESIDA (AIDS Study Group)/National Plan on AIDS with respect to the anti-retroviral treatment in adult patients infected with the human immunodeficiency virus in the year 2000 (I). Enferm Infecc Microbiol Clin 2000; 18: 329-351.

    Google Scholar 

  33. Miro JM, Antela A, Arrizabalaga J, et al. Recommendations of GESIDA (Grupo de Estudio de SIDA)/National Plan on AIDS with respect to the anti-retroviral treatment in adult patients infected with the human immunodeficiency virus in the year 2000 (II) Grupo de Estudio de SIDA (GESIDA) y por Consejo Asesor Clínico (CAC) de la Secretaria Plan Nacional. Enferm Infecc Microbiol Clin 2000; 18: 396-412.

    Google Scholar 

  34. Roberts KJ, Volberding P. Adherence communication: A qualitative analysis of physician-patient dialogue. AIDS 1999; 13: 1771-1778.

    Google Scholar 

  35. Maher K, Klimas N, Fletcher MA, et al. Disease progression, adherence, and response to protease inhibitor therapy for HIV infection in an Urban Veterans Affairs Medical Center. J Acquir Immune Defic Syndr 1999; 22: 358-363.

    Google Scholar 

  36. Knobel H, Carmona A, Grau S, Pedro-Botet J, Diez A. Adherence and effectiveness of highly active antiretroviral therapy [letter]. Arch Intern Med 1998; 158: 1953.

    Google Scholar 

  37. Miller LG, Hays RD. Adherence to combination antiretroviral therapy: Synthesis of the literature and clinical implications. AIDS Read 2000; 10: 177-185.

    Google Scholar 

  38. Roca B, Gomez CJ, Amedo A. Adherence, side effects and efficacy of stavudine plus lamivudine plus nelfinavir in treatment-experienced HIV-infected. J Infect 2000; 4: 50-54.

    Google Scholar 

  39. Wenger N, Gifford AL, Liu H, et al. Patient characteristics and attitudes associated with antiretroviral adherence. 6th Conference on Retroviruses and Opportunistic Infections. Chicago, February 1999 [abstract 96].

  40. Gifford AL, Bormann JE, Shively MJ, Wright BC, Richman DD, Bozzette SA. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr 2000; 23: 386-395.

    Google Scholar 

  41. Murri R, Ammassari A, De Luca A, et al. Self-reported nonadherence with antiretroviral drugs predicts persistent condition. HIV Clin Trials 2001; 2: 323-329.

    Google Scholar 

  42. Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis 2000; 30(Suppl 2): S171-S176.

    Google Scholar 

  43. Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: Risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999; 131: 81-87.

    Google Scholar 

  44. Knobel H, Codina C, Miro JM, et al. The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers. Enferm Infecc Microbiol Clin 2000; 18: 27-39.

    Google Scholar 

  45. Call SA, Klapow JC, Stewart KE, et al. Health-related quality of life and virologic outcomes in an HIV clinic. Qual Life Res 2000; 9: 977-985.

    Google Scholar 

  46. De la Fuente J, Ocampo A, Cadarso-Suárez C. Adherencia en relación con la toma de medicación antirretroviral. In: de la Fuente J, Cadarso-Suárez C (eds), El reto de la adherencia al tratamiento antirretroviral, Santiago de Compostela: Universidad de Santiago de Compostela-Xunta de Galicia, 2002; 159-175.

    Google Scholar 

  47. Carballo E, Cadarso-Suárez C. CVRS y tratamientos antirretrovirales. In: Carballo E, Cadarso-Suárez C, Carrera I, Fraga J (eds), Calidad de vida relacionada con la salud en pacientes sometidos a terapia antirretroviral, Santiago de Compostela: Universidad de Santiago de Compostela-Xunta de Galicia, 2002; 217-233.

    Google Scholar 

  48. Max B, Sherer R. Management of the adverse effects of antiretroviral therapy and medication adherence. Clin Infect Dis 2000; 30(Suppl) 2: S96-S116.

    Google Scholar 

  49. Montaner JSG, Reiss P, Cooper D, et al. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients: The INCAS trial. JAMA 1998; 279: 930-937.

    Google Scholar 

  50. Hurst M, Faulds D. Lopinavir. Drugs 2000; 60: 1371-1381.

    Google Scholar 

  51. Eron J, Yetzer E, Poertz D, et al. CombivirTM, a fixed formulation of lamivudine 150 mg and zidovudine 300 mg, given BID plus a protease inhibitor compared to 3TC 150 mg BID and ZDV 300 mg. 5th Conference on Retroviruses and Opportunistic Infections. Chicago, January 2000 [abstract 387].

  52. Raffi F, Cremieux AC, Katlama C, et al. Steady-state pharmacokinetics of a new triple combination tablet (TCT) containing abacavir (ABC), lamivudine (3TC) and zidovudine (ZDV) in subjects with HIV-1 infection. XIII International Conference on AIDS. Durban, July 2000 [abstract WePeB4125].

  53. Páramo M. Interacción del estres social y apoyo social con patologyía psíquica en el estudio comunitario de epidemiología psiquiátrica de Galicia. Doctoral Thesis. Santiago de Compostela: University of Santiago de Compostela; 1995.

    Google Scholar 

  54. Sullivan LM, Stein MD, Savetsky JB, Samet JH. The doctor-patient relationship and HIV-infected patients'satisfaction with primary care physicians. J Gen Intern Med 2000; 15: 462-469.

    Google Scholar 

  55. Tsasis P. Adherence assessment to highly active antiretroviral therapy. AIDS Patient Care STDS 2001; 15: 109-115.

    Google Scholar 

  56. Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care 1996; 8: 261-269.

    Google Scholar 

  57. Safren SA, Otto MW, Worth JL, et al. Two strategies to increase adherence to HIV antiretroviral medication: Life-steps and medication monitoring. Behav Res Ther 2001; 39: 1151-1162.

    Google Scholar 

  58. Angelino AF, Treisman GJ. Management of psychiatric disorders in patients infected with human immunodeficiency virus. Clin Infect Dis 2001; 33: 847-856.

    Google Scholar 

  59. Newshan G, Taylor B, Gold R. Sexual functioning in ambulatory men with HIV/AIDS. Int J STD AIDS 1998; 9: 672-676.

    Google Scholar 

  60. Schrooten W, Colebunders R, Youle M, et al. Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS 2001; 15: 1019-1023.

    Google Scholar 

  61. Wu AW. Quality of life assessment comes of age in the era of highly active antiretroviral therapy. AIDS 2000; 14: 1449-1451.

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Hospital Clínico Universitario, Santiago de Compostela, Spain

    E. Carballo & A. Prieto

  2. Unit of Biostatistics, Department of Statistics and Operations Research, University of Santiago de Compostela, Spain

    C. Cadarso-Suárez

  3. Comisionado del Plan de Galicia sobre Drogas, Xunta de Galicia, Santiago de Compostela, Spain

    I. Carrera & J. Fraga

  4. Department of Internal Medicine, Hospital Xeral Cíes, Vigo, Spain

    J. de la Fuente & A. Ocampo

  5. Department of Internal Medicine, Hospital Montecelo, Pontevedra, Spain

    R. Ojea

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  1. E. Carballo
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Carballo, E., Cadarso-Suárez, C., Carrera, I. et al. Assessing relationships between health-related quality of life and adherence to antiretroviral therapy. Qual Life Res 13, 587–599 (2004). https://doi.org/10.1023/B:QURE.0000021315.93360.8b

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