The influence of symptom experiences and attributions on adherence to highly active anti-retroviral therapy (HAART): a six-month prospective, follow-up study.

OBJECTIVE To examine changes in individuals' experiences of symptoms over the first six months of taking highly active anti-retroviral therapy (HAART) and to assess the impact of symptom experiences and attributions on adherence to HAART. METHODS A prospective study where consecutive HIV positive individuals initiating HAART completed validated questionnaires assessing their experiences of symptoms, depression, beliefs about HAART and adherence, before starting treatment and after one, three and six months of treatment. RESULTS Rates of low (<95%) adherence to HAART increased over time (p<0.001). Overall, the number of HIV or HAART-related symptoms reported did not change significantly over follow-up. However, symptom experiences differed between those reporting high (> or =95%) adherence and those reporting low adherence. Individuals reporting high adherence experienced a decrease in symptoms they attributed to HIV (p<0.05), and a decrease in the symptoms they attributed to HAART-side effects (p<0.05) over time. This decrease in symptoms over time was not seen among individuals reporting low adherence. A lack of symptomatic improvement was associated with increasing doubts about the continued necessity for HAART (p<0.05). CONCLUSIONS The findings suggest that adherence to HAART is influenced by individuals' experiences of both HIV and HAART-related symptoms. Patients who experience persistent symptoms while on HAART may begin to doubt their continued need for treatment and respond by missing doses. These findings have implications for the development of evidence-based interventions to increase adherence.