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Patient Support Helps AIDS Treatment

Depression, Low Self-Esteem Keep Some From Taking Medication
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Nov. 8, 2002 -- Thirty-nine-year-old Rick Otterbein owes his life to the ever-changing regimen of drugs he has taken in the 17 years since he learned he was HIV-positive. He watched a lover and several close friends die of AIDS, and is grateful to be alive. But he has also struggled with treatment and, at times, has even abandoned his medications because taking them was just too difficult.

"At one point I was taking 24 pills a day, and I just couldn't do it," he tells WebMD. "Psychologically, taking so many pills was making me sicker than I already was. It was a constant reminder that I had this illness that could kill me. You can't forget because your life revolves around taking medication."

More than 800,000 people in the United States are living with HIV, and many of them are on the new therapies that have transformed AIDS from a sure killer to a disease that can be managed. But there is growing evidence that adherence to these treatments is often compromised by treatment-related depression and other psychological issues.

In an effort to identify predictors of psychological well-being among HIV patients taking highly active antiretroviral therapy (HAART), researcher Steven Safren, PhD, and colleagues at Massachusetts General Hospital surveyed 84 such patients participating in a 12-week study of treatment adherence. Their findings are reported in the latest issue of the journal Psychosomatics.

The researchers first assessed levels of depression, quality of life, and self-esteem, using standardized questionnaires. They then asked the patients to complete surveys assessing particular life events, perceived social support and coping styles.

Patients with adequate social support and good coping skills were least likely to report depression, poor quality of life, and low self-esteem. But patients who perceived their HIV status as a punishment were more likely to report low self-esteem and depression.

According to Safren, the idea that HIV is a punishment is a common clinical response that is independently predictive of depression. Although the study did not specifically look at treatment adherence, he said other studies have shown that poor adherence is associated with depression and low self esteem.

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