Complex HIV treatment regimens and patient quality of life.

Abstract Recent advances in the treatment of HIV/AIDS have led to medical improvements for persons living with the virus. As a result, many now think of HIV infection as a chronic rather than a terminal illness. Along with this shift comes the understanding that individuals now live with treatments that require long-term adherence to regimens that are complex, time consuming, and not without deleterious side effects. greater life expectancy, nature of new treatments and their dependence on regimented adherence has recently led to the investigation of psychosocial variables loosely categorized as quality of life (QOL). Although there has been relatively little research on the topic in relation to new HIV therapies, what is known is that QOL - with all of its complications and dimensions - appears to play an essential role in HIV and HIV treatment. Moreover, QOL would seem to be a most worthwhile component to further investigations of improved therapies and betterment for the lives of infected individuals. following literature review discusses these issues, highlights key research findings, and provides directions for further research. Recent developments in the management of HIV/AIDS have brought about dramatic alterations in the lives of persons infected by the virus. introduction of more effective treatments, especially highly active antiretroviral therapy regimens (HAART) have not only resulted in lower viral loads, but also made significant impacts on morbidity and mortality (Altice & Friedland, 1998; Faber & McDaniel, 1999; Holzemer, Henry, Portillo, & Miramontes, 2000; Jeffe, Meredith, Mundy, & Fraser, 1998; Singh et al., 1999). In fact, as Singh et al. state, The remarkable success of the newer antiretroviral therapeutic regimens, with their ability to achieve durable suppression of HIV replication, have transformed HIV infection into a chronic manageable (p. 824). Antiretroviral medications are documented in the prolonging survival of individuals infected with HIV and, hence, in the status change of the disorder to one requiring long-term management and continued ongoing treatment (Bright, 1999;Jeffe et al., 1998). This is noteworthy in that ongoing treatment is the daunting and complex nature of the regimens that are part of HAART (Altice & Friedland, 1998; Bright, 1999; Holzemer et al., 1999). Further, these complicated and time-consuming treatments require rigorous adherence, with a medication cut-off point typically stipulated at 80% of doses taken for an adherence/ nonadherence distinction (Rabkin & Chesney, 1999; Williams, 1999). Conscientious maintenance is necessary in order to achieve full treatment effect and avoid increased viral loads, and the possibility of viral mutation and resistance (Holzemer et al., 1999; Holzemer et al., 2000; Mostashiri, Riley, Selwyn, & Altice, 1998; Singh et al., 1999). transition of HIV infection to a chronic disorder involving relatively complex treatments dependent on diligent patient adherence raises the need to consider how these treatments affect psychological integrity and the quality of life (QOL) of infected individuals. QOL includes dimensions of well-being spanning the physical, mental, and social, and including a diversity of aspects from direct symptomology and daily functioning to work performance and emotional status (Anderson, Hollenberg, & Williams, 1999; Cramer, 1999; Keith & Schalock, 1992, 1994). Medical diagnoses and treatments have implications that extend beyond the disease or infirmity, however; as Cramer notes, such matters are often not brought to the attention of the physician (p. S52). However, in the context of HIV/AIDS, QOL concerns are particularly relevant because they have been directly correlated with adherence to treatment regimens (Anderson et al., 1999; Holzemer et al., 1999; Holzemer et al., 2000; Mostashiri et al., 1998; Pequegnat & Stover, 1999; Singh et al. …

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