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Self-Reported Symptoms and Medication Side Effects Influence Adherence to Highly Active Antiretroviral Therapy in Persons With HIV Infection

Ammassari Adriana; Murri, Rita; Pezzotti, Patrizio; Trotta, Maria Paola; Ravasio, Laura; De Longis, Patrizio; Caputo, Sergio Lo; Narciso, Pasquale; Pauluzzi, Sergio; Carosi, Giampiero; Nappa, Salvatore; Piano, Paola; Izzo, Crescenzo M.; Lichtner, Miriam; Rezza, Giovanni; Monforte, Antonella d'Arminio; Ippolito, Giuseppe; Moroni, Mauro; Wu, Albert W.; Antinori, Andrea; for the AdICONA Study Group
JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2001
Brief Report: PDF Only

Objectives:To identify variables predictive of nonadherence to highly active antiretroviral therapy (HAART) and to assess whether self-reported symptoms or medication side effects are related to adherence.

Design:Cross-sectional multicenter study Adherence Italian Cohort Naive Antiretrovirals [AdICONA] within the Italian Cohort Naive Antiretrovirals (ICONA).

Methods:Participants receiving HAART completed a 16-item self-administered questionnaire to assess nonadherence in the last 3 days as well as the type and intensity of 24 common HIV- and HAART-related symptoms experienced during the last 4 weeks.

Results:From May 1999 to March 2000, 358 persons were enrolled: 22% reported nonadherence and were less likely to have HIV RNA <500 copies/ml (odds ratio = 0.51; 95% confidence interval: 0.31-0.85). Frequency of moderate/severe symptoms or medication side effects in nonadherent participants ranged from 3.6% to 30%. On univariate analysis, nausea, anxiety, confusion, vision problems, anorexia, insomnia, taste perversion, and abnormal fat distribution were significantly associated with nonadherence. Nonadherent persons had a higher mean overall symptom score (12.3 ± 9.2 versus 8.1 ± 6.6; p < .001) and mean medication side effect score (2.9 ± 2.7 versus 1.9 ± 1.9; p < .001) when compared with adherent participants. In the multivariate analysis, nausea (p = .003); anxiety (p = .006); younger age (p = .007); unemployment (p < .001); not recalling name, color, and timing of drugs (p = .009); running out of pills between visits (p = .002); and being too busy (p = .03) were independently associated with nonadherence in the last 3 days.

Conclusions:In addition to patient characteristics, medication-related variables, and reasons for nonadherence, patient-reported symptoms and medication side effects were significantly associated with adherence to HAART.

Address correspondence and reprint requests to Adriana Ammassari, Clinica delle Malattie Infettive, Catholic University; L.go A. Gemelli 8, 00168 Rome, Italy; e-mail:

Manuscript received January 30, 2001; accepted August 8, 2001.

© 2001 Lippincott Williams & Wilkins, Inc.