Monday, November 3, 2003

This presentation is part of : Lipodystrophic Symptomatology, Medication Adherence, Depression, CAM Therapies, and Health-Related Quality of Life in Persons with HIV Disease

Relationship between lipodystrophy-associated symptoms and medication adherence in persons infected with HIV/AIDS

Inge B. Corless, RN, PhD, FAAN1, Kenn M. Kirksey, RN, PhD, APRN, BC2, Patrice Kenneally Nicholas, RN, DNSc, MPH, ANP1, Jeanne Kemppainen, RN, PhD, CNS3, and Margaret E. Mueller, RN, MSN4. (1) Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA, (2) Department of Nursing, California State University, Fresno, Fresno, CA, USA, (3) School of Nursing, The University of North Carolina at Wilmington, Wilmington, NC, USA, (4) Department of Nursing, Veteran's Administration Healthcare System/CSU Fresno, Fresno, CA, USA

Lipodystrophy-associated manifestations such as body fat changes, and increases in glucose and lipid levels remain a challenge for HIV-infected persons and their providers. Given that side effects of medications, as well as symptomatic HIV disease have been implicated in non-adherence, the implications of lipodystrophy for adherence are a concern. Objective: This study was designed to determine the relationship between time of initial diagnosis, presence of lipodystrophic symptomatology, and adherence to medication regimens in persons with HIV/AIDS. Design: Cross-sectional, descriptive design. Population, Sample, Setting: The sample consisted of 165 persons from three outpatient HIV clinics in Boston MA, Fresno CA, and Victoria TX. Variables: This paper examined the relationship between lipodystrophic symptoms seen in HIV/AIDS and adherence to antiretroviral medications. Methods: Participants were asked to complete open-ended questions regarding presence and types of lipodystrophy-associated symptoms, self-reported management of body fat alterations, and how these physical changes made them feel. Adherence was measured using the Morisky Medication Adherence Scale (MMAS). Findings: On a Likert-type scale ranging from 0-4, with “0” indicating “very adherent” and “4” indicating “non-adherent,” the mean score on the MMAS was 1.44 (SD + 1.34). This finding demonstrated that the participants consistently took their medications despite self-reports of significant numbers of HIV disease and treatment-related body fat changes. However, there was a negative correlation between medication adherence and years of HIV positive status. Conclusions: These findings are somewhat in contrast to what is widely reported in the scientific literature. Subjects in this study did report a high level of adherence to medication regimens despite the purported association with lipodystrophy. Length of time since initial diagnosis with HIV, however, had a negative impact on medication adherence. Implications: Further research is required to examine adherence over time. Prospective studies that evaluate symptoms and adherence issues in HIV-infected persons are also warranted.

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