Leone Daniela, Borghi Lidia, Lamiani Giulia, Barlascini Luca, Bini Teresa, d'Arminio Monforte Antonella, Vegni Elena
Unit of Clinical Psychology, Department of Health Sciences, University of Milan Milan, Italy.
Department of Biomedical Sciences, Humanitas University Milan, Italy.
Front Psychol. 2016 Dec 23;7:1991. doi: 10.3389/fpsyg.2016.01991. eCollection 2016.
It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement. HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients' clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success. A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient's life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient's perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309). Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.
对于艾滋病毒呈阳性的患者而言，参与自身护理并坚持治疗以减缓疾病进展和降低死亡率至关重要。研究发现，疾病认知通过应对行为的中介作用影响治疗依从性。然而，尚无研究检验患者参与就诊是否会介导疾病认知与治疗依从性之间的关系。本研究旨在探究艾滋病毒呈阳性患者的疾病认知，并检验以下假设：疾病认知通过行为参与的一个组成部分的中介作用来预测治疗依从性。接受高效抗逆转录病毒疗法（HAART）治疗至少一年且前来进行体检的艾滋病毒呈阳性患者有资格参与本研究。患者完成了修订后的疾病认知问卷。行为参与基于患者对体检就诊的临床出勤情况进行衡量；HAART治疗的依从性通过病毒载量来衡量。病毒载量检测不到或HIV-RNA<40拷贝/毫升被视为病毒学成功的指标。共有161名患者参与了本研究。他们中的大多数人一致将所经历的症状归因于艾滋病毒/HAART；将自己的病情视为慢性、稳定、连贯，认为治疗有效，并将疾病归因于艾滋病毒以及自身行为或运气不好。大多数患者（80.1%）定期进行体检就诊，其中88.5%的患者实现了病毒学成功。中介模型未显示出良好的拟合指数。然而，发现两个自变量对病毒学成功有显著的直接影响。具体而言，认为疾病对患者生活没有严重后果的认知以及对艾滋病毒的负面情绪流行率与病毒学成功相关。相反，患者认为疾病对其生活有严重后果的认知以及积极情绪的流行率与病毒学失败相关。该模型显示出良好的拟合指数（CFI = 1；TLI = 1；RMSEA = 0.00；WRMSR = 0.309）。结果不支持行为参与在疾病认知与治疗依从性之间关系中的中介作用。由于对严重后果的认知加上积极情绪与病毒学失败直接相关，临床医生应考虑到这些因素以促进治疗依从性。
