Therapietrouw en kwaliteit van leven bij ouder wordende hiv-1-patiënten

Summary

Treatment adherence, health-related quality of life and aging in HIV-1 infected patients
Nienke Langebeek

Adherence to combination antiretroviral therapy (cART) in the treatment of HIV infection is essential in securing sustained treatment success. At least 95% adherence levels are required, and suboptimal adherence may compromise treatment efficacy and result in selection of drug-resistant viral variants. Adherence is considered to be a complex behavior that is influenced by a wide range of factors. Healthcare professionals need information about predictors and correlates of adherence, to prepare and support patients in achieving and maintaining good levels of adherence.
Optimal adherence can contribute to the maintenance of one’s health and can contribute to one’s quality of life. Due to the advent of cART, life expectancy has increased significantly in HIV-infected adults.

The objectives of the thesis are:

1. To examine which factors predict patients’ adherence
2. To compare different methods of assessing adherence and to identify interventions that enhance and sustain high levels of adherence
3. To examine how patients, who are getting older with HIV infection and develop more co-morbidities associated with aging, experience their healthrelated quality of life.

The outline of the thesis: The first part – Factors influencing adherence – not only focuses on such factors, but also whether use of a simplified cART regimen improves adherence, treatment satisfaction and health-related quality of life.
In the second part – Assessment of and interventions on adherence – we investigated assessment strategies of adherence and interventions to improve and maintain adherence levels. And in the third part – Health Related Quality of Life and aging – we investigated Health Related Quality of Life (HRQL) in HIV-infected individuals and a highly comparable uninfected control group. The objectives of this analysis were to investigate the independent impact of the number of comorbidities, aging and HIV-infection on HRQL and depression.
CONCLUSION: Despite the availability of a new generation of HIV-medicines and the possibilities of Single Tablet Regimen (STR) on a daily basis, interventions reducing the negative effects of influencing factors, especially psychosocial factors thwarting adherence remains an important focus in counseling patients. Nurses treating patients with HIV need to be aware of the common co-morbidities patients may face as they age with HIV. Nursing interventions such as management of HIV and its co-morbidities, in particular to social and psychosocial support, may minimize negative effects on HRQL.
Nurse researchers need to examine new strategies to improve and maintain adherence levels in this changing population of aging HIV-infected individuals, and find strategies tailored to their needs to maintain an acceptable HRQL.

Key words: hiv, antiretroviral therapy, adherence, quality of life, aging