Pre-Treatment Beliefs May Influence Adverse Effects with Antiretroviral Therapy

Patients’ beliefs about medications prior to treatment initiation of antiretroviral therapy (ART) may be a reliable predictor of adverse effects (AEs) and eventual nonadherence and discontinuation, according to a new study published in AIDS and Behavior.

Newer ART agents have been associated with lower incidence of treatment-limiting AEs; however, patients still report non-specific AEs, such as fatigue and nausea. AEs are one of the most common reasons for treatment switches and nonadherence, leading to suboptimal outcomes.

For this study, the researchers evaluated whether specific and general medication beliefs, or other psychological factors, such as depression and anxiety, may predict AE reports in HIV.

“Factors such as verbal suggestion and negative treatment experiences can induce side effects in people taking both placebos and active drug treatment,” the researchers wrote in the study. “A better understanding of the determinants of side effects of ARTs could help health care professionals to identify patients who are at risk of developing side effects and offer appropriate support.”

A total of 120 patients were eligible and 67 patients provided data at each time point, forming the sample for this study. These patients received follow-up questionnaires after 1, 6, and 12 months of ART treatment, as well as telephone reminders to optimize response rates. ART AEs were measured using a modified version of the Identity subscale of the Illness Perceptions Questionnaire-Revised comprising 12 common HIV/ART related symptoms. To measure AEs, patients indicated which symptoms they experienced and rated the severity of each symptom.

The researchers evaluated beliefs about medications using the Beliefs About Medicines Questionnaire. Patients also used the Perceived Sensitivity to Medicines Scale and Hospital Anxiety and Depression Scale to determine body response to the medications and presence of clinical anxiety/depression.

Regarding adherence, patients who reported taking less than 95% of ART medicines were categorized into a low adherence group, whereas those taking more than 95% of their medications were allocated to a high adherence group.

According to the data, the number of patients reporting high adherence increased from 6.6% at 1 month to 22.4% at 12 months. AEs at 6 months appeared to predict nonadherence at 12 months. Patients with high adherence at 12 months reported fewer AEs at 6 months than patients with low adherence, a mean of 2.5 and 5.8, respectively. Additionally, patients with high adherence at 12 months reported a mean of 3.4 AEs at 1 month and patients with low adherence reported a mean of 5.5 AEs.

Furthermore, the findings indicated that AEs at 1 month and 6 months were strongly tied with depression and anxiety scores, as well as perceived sensitivity to medicines.

“Consistent with studies in other long-term conditions we found concerns about ART were influenced by patients’ beliefs about medicines in general, specifically beliefs that medicines are fundamentally harmful, addictive substances that should not be taken for long periods of time and perceptions of personal sensitivity to adverse effects,” the researchers explained.

The current study concluded that patients’ concerns about their treatments prior to initiation predicted subsequent reporting of ART AEs, indicating that patients with negative expectations or concerns about ART may be at higher risk of AEs and nonadherence.

References

Horne B, Chapman S, Glendinning E, et al. Mind matters: treatment concerns predict the emergence of antiretroviral therapy side effects in people with HIV. AIDS and Behavior. Published February 2019. https://doi.org/10.1007/s10461-018-2239-6