A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy
A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy
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DOI：
10.1080/13548506.2014.945601
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发表时间：
2015-04-03
影响因子：
3.8
通讯作者：
Leffingwell, Thad R.
中科院分区：
文献类型：
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作者：
Claborn, Kasey R.;Meier, Ellen;Leffingwell, Thad R.
艾滋病毒的治疗需要终身坚持药物治疗方案，包括不方便的时间表、不良副作用和生活方式的改变。抗逆转录病毒的坚持与治疗疲劳有着千丝万缕的联系。艾滋病毒感染人群中的依从性已经得到了很好的调查；然而，对治疗疲劳知之甚少。这篇综述考察了关于艾滋病毒人群中治疗疲劳的文献现状，并提供了其病因和潜在后果的概述。使用标准的系统研究方法收集有关治疗疲劳和艾滋病毒的已发表论文。使用PRISMA标准搜索了5个数据库。在确定的1557项研究中，21项符合以下纳入标准：(A)研究参与者感染了艾滋病毒；(B)给参与者开了抗逆转录病毒药物；(C)文章提到了治疗疲劳；(D)文章发表在同行评议期刊上；(E)文章有英文版本。只有七篇文章对治疗疲劳进行了操作性定义，在整个定义中出现了三个主题：(1)药片负担；(2)失去坚持治疗方案的意愿；(3)由于治疗疲劳而不坚持治疗方案。根据这些研究，治疗疲劳可被定义为“患者在遵守长期处方的治疗方案时，保持警惕的意愿和动机降低。”治疗疲劳的原因和病程似乎因发育阶段而异。到目前为止，只检查了结构化治疗中断作为减少儿童和成人治疗疲劳的干预措施。目前还没有开发出可以减少治疗疲劳的行为干预措施。此外，只有定性研究从概念上检验了治疗疲劳。需要进行旨在系统评估治疗疲劳的研究。增加对治疗疲劳的病程和持续时间的了解有望改善坚持干预措施，从而改善艾滋病毒携带者的临床结果。
HIV treatment requires lifelong adherence to medication regimens that comprise inconvenient scheduling, adverse side effects, and lifestyle changes. Antiretroviral adherence and treatment fatigue have been inextricably linked. Adherence in HIV-infected populations has been well investigated; however, little is known about treatment fatigue. This review examines the current state of the literature on treatment fatigue among HIV populations and provides an overview of its etiology and potential consequences. Standard systematic research methods were used to gather published papers on treatment fatigue and HIV. Five databases were searched using PRISMA criteria. Of 1557 studies identified, 21 met the following inclusion criteria: (a) study participants were HIV-infected; (b) participants were prescribed antiretroviral medication; (c) the article referenced treatment fatigue; (d) the article was published in a peer-reviewed journal; and (e) text was available in English. Only seven articles operationally defined treatment fatigue, with three themes emerging throughout the definitions: (1) pill burden; (2) loss of desire to adhere to the regimen; and (3) nonadherence to regimens as a consequence of treatment fatigue. Based on these studies, treatment fatigue may be defined as "decreased desire and motivation to maintain vigilance in adhering to a treatment regimen among patients prescribed long-term protocols." The cause and course of treatment fatigue appear to vary by developmental stage. To date, only structured treatment interruptions have been examined as an intervention to reduce treatment fatigue in children and adults. No behavioral interventions have been developed to reduce treatment fatigue. Further, only qualitative studies have examined treatment fatigue conceptually. Studies designed to systematically assess treatment fatigue are needed. Increased understanding of the course and duration of treatment fatigue is expected to improve adherence interventions, thereby improving clinical outcomes for individuals living with HIV.