Mind Matters: Treatment Concerns Predict the Emergence of Antiretroviral Therapy Side Effects in People with HIV

Reversibility of Neuropsychiatric Adverse Events after Switching to Darunavir/Cobicistat or Doravirine in Men on INSTI-Based Regimen

Integrase strand transfer inhibitors (INSTI) are associated with neuropsychiatric adverse events (NPAEs). The aim of this study was to evaluate improvements in NPAEs after switching an INSTI-based regimen to darunavir/cobicistat (DRV/c) or doravirine (DOR). Methods: A prospective cohort study was conducted to evaluate the reversibility of NPAEs via the Patient Health Questionnaire (PHQ-9), the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS-A and D) in patients who started antiretroviral therapy with dolutegravir (DTG) or bictegravir (BIC). These patients were switched to DRV/c or DOR. Scales were compared at the moment of the switch and 12 weeks later. Results: We included 1153 treatment-naïve men, 676 (58.7%) with BIC and 477 (41.3%) with DTG. A total of 32 (2.7%) experienced NPAEs that led to discontinuation. Insomnia was found in 20 patients; depression via PHQ-9 in 21 patients, via HADS-D in 5 patients, and anxiety via HADS-A in 12 patients. All of them were evaluated by a psychiatrist at the moment of the symptoms; 7 (21.8%) started psychotropic drugs. After 12 weeks of follow-up, PHQ-9, ISI, HADS-A, and HADS-D decreased, with a p-value ≤ 0.05. Conclusions: NPAEs seem to improve after switching to a DRV/c- or DOR-based regimen after the first 4 and 12 weeks.

Perceived sensitivity to medicines and medication concerns beliefs predict intentional nonadherence to antiretroviral therapy among young people living with HIV

Objective: Among the sources of antiretroviral therapy (ART) nonadherence are patient decisions to skip or stop taking their medications, often stemming from medication beliefs and concerns about side- effects. While individuals who perceive greater sensitivity to medicines may be prone to medication concerns, understanding how these factors contribute to HIV treatment adherence requires further research. The current study tested the direct and indirect effects of perceived sensitivity to medicines on intentional nonadherence to ART, and whether medication concerns mediate this association.

Methods: A sample of 418 younger (< 36 years of age) people living with HIV was recruited through community outreach to complete assessments of perceived sensitivity to medicines, medication concerns beliefs, adherence assessed by unannounced phone- based pill counts and HIV viral load, as well as monthly follow- up assessments of intentional nonadherence over a 15- month period.

Results: Analyses at baseline and prospective Poisson regression models conducted over 15- months converged to show that perceived sensitivity to medicines significantly predicted intentional nonadherence to ART through medication concerns.

Conclusions: These findings suggest that people who perceive greater sensitivity to medicines are prone to greater medication concerns that are related to intentional nonadherence. Cognitive behavioral interventions are needed to resolve medication concerns and reduce intentional nonadherence among people receiving ART.

Insertion of an Amphipathic Linker in a Tetrapodal Tryptophan Derivative Leads to a Novel and Highly Potent Entry Inhibitor of Enterovirus A71 Clinical Isolates

AL-471, the leading exponent of a class of potent HIV and enterovirus A71 (EV-A71) entry inhibitors discovered in our research group, contains four l-tryptophan (Trp) units bearing an aromatic isophthalic acid directly attached to the C2 position of each indole ring. Starting from AL-471, we (i) replaced l-Trp with d-Trp, (ii) inserted a flexible linker between C2 and the isophthalic acid, and (iii) substituted a nonaromatic carboxylic acid for the terminal isophthalic acid. Truncated analogues lacking the Trp motif were also synthesized. Our findings indicate that the antiviral activity seems to be largely independent of the stereochemistry (l- or d-) of the Trp fragment and also that both the Trp unit and the distal isophthalic moiety are essential for antiviral activity. The most potent derivative, 23 (AL-534), with the C2 shortest alkyl urea linkage (three methylenes), showed subnanomolar potency against different EV-71 clinical isolates. This finding was only observed before with the early dendrimer prototype AL-385 (12 l-Trp units) but remained unprecedented for the reduced-size prototype AL-471. Molecular modeling showed the feasibility of high-affinity binding of the novel l-Trp-decorated branches of 23 (AL-534) to an alternative site on the VP1 protein that harbors significant sequence variation among EV-71 strains.

Change in Nutritional and Biochemical Status in People Living with HIV-1 on Antiretroviral Therapy

Antiretroviral therapy (ART) improves the quality of life of people living with HIV-1 (PLHIV) and reduces the mortality rate, but some individuals may develop metabolic abnormalities. This study evaluated changes in the nutritional status and biochemistry of PLHIV on antiretroviral therapy in a cohort that had not previously received ART and to follow up these individuals for 24 months after starting treatment. The initial cohort consisted of 110 individuals and ended with 42 people, assessed by a physical examination. A biochemical assay was performed using the colorimetric enzyme reaction technique, the proviral load was detected by qPCR and the quantification of the CD4/CD8 T lymphocytes was conducted by flow cytometry. PLHIV had increased levels of total cholesterol, LDL, triglycerides, ALT, urea and creatinine after 24 months of ART use (p < 0.05). In the assessment of the nutritional status, PLHIV had increased measures of Triciptal Skinfold, body mass index and arm circumference after the use of ART (p < 0.05). The viral load levels decreased and the CD4 levels increased after 24 months of ART use (p < 0.05). The change in the nutritional status in PLHIV on antiretroviral therapy seems to be a slow process, occurring in the long term, therefore, there is the need for a constant evaluation of these people to identify patients who need a nutritional intervention.

Beliefs About Medicines Predict Side-Effects of Placebo Modafinil

BACKGROUND

Patients receiving placebo in clinical trials often report side-effects (nocebo effects), but contributing factors are still poorly understood.

PURPOSE

Using a sham trial of the cognition-enhancing "smart pill" Modafinil we tested whether medication beliefs and other psychological factors predicted detection and attribution of symptoms as side-effects to placebo.

METHODS

Healthy students (n = 201) completed measures assessing beliefs about medication, perceived sensitivity to medicines, negative affectivity, somatization, and body awareness; 66 were then randomized to receive Deceptive Placebo (told Modafinil-given placebo, 67 to Open Placebo (told placebo-given placebo, and 68 to No Placebo. Memory and attention tasks assessed cognitive enhancement. Nocebo effects were assessed by symptom checklist.

RESULTS

More symptoms were reported in the Deceptive Placebo condition (M = 2.65; SD = 2.27) than Open Placebo (M = 1.92; SD = 2.24; Mann-Whitney U = 1,654, z = 2.30, p = .022) or No Placebo (M = 1.68; SD = 1.75, Mann-Whitney U = 1,640, z = 2.74, p = .006). Participants were more likely to attribute symptoms to Modafinil side-effects if they believed pharmaceuticals to be generally harmful (incidence rate ratio [IRR] = 1.70, p = .019), had higher perceived sensitivity to medicines (IRR = 1.68, p = .011), stronger concerns about Modafinil (IRR = 2.10, p < .001), and higher negative affectivity (IRR = 2.37, p < .001).

CONCLUSIONS

Beliefs about medication are potentially modifiable predictors of the nocebo effect. These findings provide insight into side-effect reports to placebo and, potentially, active treatment.

Perceived sensitivity to medicines and the experience of side-effects: understanding intentional medication nonadherence among people living with HIV

Patient initiated decisions to forgo taking medications (i.e. intentional nonadherence) pose significant challenges to managing chronic health conditions. Identifying factors and their underlying mechanisms that impede medication adherence is essential to designing treatment improvement interventions. This study tested a conceptual model that posits the effects of perceived sensitivity to medicines on adherence can be explained by the experience of side-effects, leading to intentionally nonadherent behaviors. Patients receiving HIV care in the southern United States (N = 209) completed measures of perceived sensitivity to medicines, antiretroviral therapy (ART) side-effects, intentional nonadherence and overall adherence. Patients also provided consent to access their electronic medical records to collect subsequent reports of HIV viral load tests. Results indicated that more than one in four participants were intentionally nonadherent to ART. Mediation modeling showed that perceived sensitivity to medicines was associated with greater experience of ART side-effects and intentional nonadherence, which impacted overall ART adherence and HIV viral load. There were also significant indirect effects of perceived sensitivity to medicines on HIV viral load through side-effects and intentional nonadherence. Patients with increased perceived sensitivity to medicines are at risk for poor treatment outcomes and these negative outcomes are partly explained by experiencing greater side-effects and intentional nonadherence.

A life where concealment and exposure coexist-The antiretroviral therapy adherence of people living with HIV infection: A phenomenological study

AIM

The aim of this study is to identify the nature and structure of the real world experiences of people living with HIV infection and adhering to antiretroviral therapy (ART).

DESIGN

Giorgi's phenomenological method was applied.

METHODS

Data collection was conducted from 1 November 2016-1 September 2017. A total of six participants participated in the study. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this study.

RESULTS

The findings show that the structure of the experience of people living with HIV and adhering to ART is composed of six essential common constituents: (a) ART adherence has become a prerequisite for a normal life; (b) Endless adjustments responding to a sensitive body; (c) Dosing Time becomes the framework of the day; (d) Dosing time needing to coincide with the availability of confidential dosing space; (e) Classification of Relationships-those who know of my taking antiretroviral drugs and those who do not; and (f) Recognition of the multiple relationships affecting ART.

CONCLUSION

Adhering to ART is experienced by people infected with HIV not only as a process they want to hide, but also a critical lifeline that stabilizes their lives. That is, their day-to-day living is split into a double life reflecting their coexisting need for concealment and exposure.

IMPACT

Although much existing literature focuses on the adherence to medication, this study reveals the meaning of ART in the context of viewing the patient as an independent subject. Contrary with what people living with HIV want, they are at risk of external exposure during the process of treatment. This study highlights the need for nurses to communicate with patients about the strategies they need to meet the challenges they face.