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Therapy Adherence and Emotional Awareness and Regulation in Persons With Human Immunodeficiency Virus

Sofia, Sonia A., MD*; Lysaker, Paul H., PhD†‡; Smith, Elizabeth, PhD§; Celesia, Benedetto M., MD*; Dimaggio, Giancarlo, MD

The Journal of Nervous and Mental Disease: December 2018 - Volume 206 - Issue 12 - p 925–930
doi: 10.1097/NMD.0000000000000901
Original Articles

Adherence to antiretroviral therapy (ART) is a key issue for people with human immunodeficiency virus. Optimal adherence leads to benefits in terms of survival and quality of life, which do not occur with incomplete adherence. One factor that may influence adherence to ART is emotional unawareness deficits. To explore this possibility, we assessed emotional deficits and measured adherence in 100 adults using both self-report and viral load testing. Results showed that people classified as adherent in both measurements were more likely to have a greater awareness of their own emotions. Participants classified as nonadherent were more likely to have a reduced ability to recognize the emotions of others. Difficulty in recognizing one's own emotions, otherwise known as alexithymia, and impairment of the ability to recognize other's emotions may contribute to nonadherence to ART. Consequently, after repeated studies to confirm the findings, it can be considered a target for psychological therapies aimed at increasing adherence.

*Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy;

Richard L. Roudebush VA Medical Center;

Department of Psychiatry, Indiana University School of Medicine;

§Department of Psychology, Indiana State University, Indianapolis, Indiana; and

Centro di Terapia Metacognitiva Interpersonale, Rome, Italy.

Ethical standards: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

Informed consent was obtained from all individual participants included in the study.

Send reprint requests to Sonia A. Sofia, MD, Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Via Palermo, 636, Catania 95122, Italy. E-mail:

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