- Treatment adherence, health related quality of life and aging in HIV-1 infected patients
- Award date
- 8 June 2017
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
A meta-analysis on predictors and correlates of adherence to cART showed that adherence was most strongly associated with patients’ adherence-related beliefs. It suggests several potential options for interventions to improve adherence.One intervention, simplification of therapy to a fixed-dose was perceived to be more convenient, and resulted in improved adherence.There is no golden standard to measure adherence. A combination of methods were compared including EMD, diaries, self-reports, physician and nurse assessments, pill-counts, pharmacy refill, in-depth-interviews and TDM. The conclusion was that patient’s self-reports, the estimation by nurse and the combination with TDM are easy to implement and can be used successfully in daily practice.Another meta-analysis was carry out to assess the effectiveness of EMD combined with informed counselling. The contribution of just monitoring-informed counselling to improve levels of adherence and virological treatment response is difficult to establish. It reflects that adherence is a behaviour that may be affected by a multitude of factors addressed by multi-component interventions.The age of HIV-1 infected adults increasing and therefore the onset of age-associated co-morbidities increases which may negatively affect HRQL.A cohort of HIV-negative and HIV-positive individuals > 45 years were screened for the presence of co-morbidities and completed questionnaires about HRQL and depression. HIV-positive status was associated with poor physical and mental HRQL and with increased likelihood of developing depression. No evidence was found that the difference in HRQL between HIV-infected and uninfected individuals became more pronounced with a higher number of co-morbidities, or at an older age.
Abbreviations: cART: combination antiretroviral therapy; EMD: electronic monitoring device; TDM: therapeutic drug monitoring; HRQL: health related quality of life.
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