A comparison of patients' attitudes to antiretroviral toxicities between the UK and Uganda
Nelson, Mark; Mackenzie, Strachan; Yau, Stuart; Bower, Mark; Waters, Laura; Stebbing, Justin
The St Stephen's Centre, Imperial College, Chelsea and Westminster Hospital, Imperial College, London, UK.
Received 5 November, 2010
Accepted 9 November, 2010
The toxicity profile of combination antiretroviral therapy (cART) and attitudes toward this play an important role in therapy selection and thus in patients achieving good long-term compliance and adherence [1,2]. There are surprisingly few data on patient preferences here and many studies have recruited low numbers of individuals, typically those in established market economies [3–5], including patients on antiretroviral studies , which may not be reflective of the ‘real world setting’ .
Attitudes to side effects may also vary between different patient groups. Comparisons between Africa and established market economies have not been specifically undertaken. We, therefore, wished to explore the attitudes of patients with regard to cART side effects in two cohorts, one from a UK central London hospital (the Chelsea and Westminster Hospital) and the other from a rural Ugandan hospital (Kagando Mission Hospital); appropriate ethical approval was obtained.
An anonymous survey was given to and collected from patients in the out-patient department: to the best of our knowledge, the response rate was 100%. The survey asked patients to rate 10 commonly occurring cART symptoms or signs related to toxicities of antiretrovirals on a subjective scale of 1–10, in which 10 represented the most distressing value. The mean values for each group were used to rank the side effects to compare the cohorts and differences compared. A total of 159 individuals were recruited, 95 from the UK and 64 from Uganda. The average scores comparing the two cohorts and their ranking are shown (Tables 1 and 2). The largest differences in distress rankings between the two countries were sleep disturbances and increased risk of myocardial infarction (much higher in UK cohort) and diarrhea (much higher in Uganda cohort). Lipodystrophy ranked highly in both countries, but was the most distressing side effect in the UK.
Overall, the distress levels associated with a few side effects were similar in both the UK and Uganda; for example, lipodystrophy (very distressing) and weight gain (least distressing). Poor access to healthcare resources may explain why side effects such as diarrhea and vomiting were ranked so highly in Uganda and cultural differences may also contribute to differences in the acceptability of side effects.
The relationship between a patient and their physician is important in determining acceptance and adherence to cART [8–10]. Antiretroviral prescribers in established market economies should be mindful of these differences when prescribing and discussing treatment plans with patients from different cultural backgrounds.
We are grateful to the patients who completed the questionnaire.
This abstract was an oral presentation at the Second Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASSH), Manchester, April 2010.
1. Hammer SM. Clinical practice. Management of newly diagnosed HIV infection. N Engl J Med 2005; 353:1702–1710.
2. Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. JAMA 2010; 304:321–333.
3. Miller LG, Huffman HB, Weidmer BA, Hays RD. Patient preferences regarding antiretroviral therapy. Int J STD AIDS 2002; 13:593–601.
4. Ammassari A, Murri R, Pezzotti P, Trotta MP, Ravasio L, De Longis P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr 2001; 28:445–449.
5. Stone VE, Hogan JW, Schuman P, Rompalo AM, Howard AA, Korkontzelou C, Smith DK. Antiretroviral regimen complexity, self-reported adherence, and HIV patients' understanding of their regimens: survey of women in the her study. J Acquir Immune Defic Syndr 2001; 28:124–131.
6. Nieuwkerk P, Gisolf E, Sprangers M, Danner S. Adherence over 48 weeks in an antiretroviral clinical trial: variable within patients, affected by toxicities and independently predictive of virological response. Antivir Ther 2001; 6:97–103.
7. Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Ouellette VL. How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261:3273–3277.
8. Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 28:47–58.
9. Davidson I, Beardsell H, Smith B, Mandalia S, Bower M, Gazzard B, et al. The frequency and reasons for antiretroviral switching with specific antiretroviral associations: the SWITCH study. Antiviral Res 2010; 86:227–229.
10. Beach MC, Duggan PS, Moore RD. Is patients' preferred involvement in health decisions related to outcomes for patients with HIV? J Gen Intern Med 2007; 22:1119–1124.
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