English title dissertation Treatment Adherence, Health Related Quality of Life and Aging in HIV-1 infected patients
Name PhD (surname first) Langebeek Nienke
Doctor is (has been) nurse
Date of promotion 08/06/2017
University Universiteit van Amsterdam
Promotores Reiss P., Sprangers M.A.G., Nieuwkerk P.T (co-promotor)
Abstract (English)

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

A meta-analysis on predictors and correlates of adherence to cART showed that adherence was most strongly associated with patients’ adherence-related beliefs. It suggest several potential options for interventions to improve adherence.

One intervention, simplification of therapy to a fixed-dose was perceived to be more convenient, and resulted in improved adherence.

There is no golden standard to measure adherence. A combination of methods were compared including EMD, diaries, self-reports, physician and nurse assessments, pill-counts, pharmacy refill, in-depth-interviews and TDM. The conclusion was that patient’s self-reports, the estimation by nurse and the combination with TDM are easy to implement and can be used successfully in daily practice.

Another meta-analysis was carry out to assess the effectiveness of EMD combined with informed counselling. The contribution of just monitoring-informed counselling to improve levels of adherence and virological treatment response is difficult to establish. It reflects that adherence is a behaviour that may be affected by a multitude of factors addressed by multi-component interventions.

The age of HIV-1 infected adults increasing and therefore the onset of age-associated co-morbidities increases which may negatively affect HRQL.
A cohort of HIV-negative and HIV-positive individuals > 45 years were screened for the presence of co-morbidities and completed questionnaires about HRQL and depression. HIV-positive status was associated with poor physical and mental HRQL and with increased likelihood of developing depression. No evidence was found that the difference in HRQL between HIV-infected and uninfected individuals became more pronounced with a higher number of co-morbidities, or at an older age.

Abbriviations: cART: combination antiretroviral therapy; EMD: electronic monitoring device; TDM: therapeutic drug monitoring; HRQL: helath related quality of life

Download dissertation (English) PR-IPS-NienkeLangebeek-binnenwerk-DEF-UIT-low.pdf