Page 266 - Encyclopedia of Nursing Research

HIV SyMpTOM MANAGeMeNT AND QUAlITy OF lIFe n 233

(now more commonly referred to as body fat persons with body fat redistribution changes
redistribution) emerged following the incep- associated with HIV.
tion of ArV therapies (e.g., nucleoside reverse It is challenging to provide a detailed H
transcriptase inhibitors and protease inhibi- presentation of HIV-related symptoms and
tors). reports of lipoatrophy (e.g., peripheral the resulting sequelae within the confines
fat loss of the face, extremities and buttocks) of this chapter. Although the symptoms ini-
in HIV-infected persons have ranged from tially associated with HIV (e.g., Kaposi’s sar-
28% to 37% (Bernasconi et al., 2002; Santos coma, P. carinii pneumonia) now appear less
et al., 2005). In a related study, 27% of study frequently, the advent of ArV therapy has
participants (N = 745) reported lipohyper- resulted in new symptom presence that can
trophic manifestations like breast enlarge- be as troubling as those found decades ago.
ment, central hypertrophy, and buffalo hump Symptoms like nausea, diarrhea, and fever
(Heath et al., 2002). These body fat changes still persist; however, entities like lipodystro-
have frequently caused increased stigma phy have emerged as more contemporary
and diminished HrQOl, often resulting issues. The results can often be the same as
in self-image dysmorphia, development of those observed in the early 1980s. Individuals
depressive symptoms, and nonadherence to living with HIV/AIDS continue to experience
treatment regimens (rajagopalan, laitinen, & anxiety and self-image disturbances associ-
Dietz, 2008). ated with comorbidities, medication side
corless et al. (2005) conducted a descrip- effects, and body fat changes. These factors
tive, exploratory study (N = 165) to exam- can impact daily activities, affect medication
ine relationships between the presence of adherence, result in increased depressive
lipodystrophic and depressive symptoms, symptom presence, enhance disease-related
social support, quality of life, comorbidities, stigmata, and decrease HrQOl. rajagopalan
and ArV adherence. patients experiencing et al. (2008) reported similar findings regard-
HIV medication-related body fat changes ing significant reductions in HrQOl in per-
were only “moderately adherent” (p. 582) to sons experiencing lipoatrophy. They also
ArV therapy, with as many as 57.6% admit- noted that “HIV-infected individuals expe-
ting forgetting to take their medications, or rience a considerable reduction in health-
intentionally failing to adhere to the pre- related quality of life compared to the general
scribed regimen. Sixty-seven percent of the population” (p. 1201).
sample reported comorbidities, with depres- It is imperative that we continue to
sion, diabetes, hepatitis, and hypertension reshape symptom management programs
occurring most frequently. More than 80% for persons living with and affected by HIV/
of the respondents indicated significant lev- AIDS. Nurses are well positioned to assist
els of depressive symptoms, as measured by clients with symptom management, particu-
the center of epidemiological Studies larly self-care measures that have been val-
Depression Scale (radloff, 1977). There idated through numerous scientific studies
was also a significant relationship between and opinions of clinical experts in the field
the center of epidemiological Studies of HIV. Spirig et al. (2005) suggested that
Depression Scale scores and medication “nurses and researchers work together to
nonadherence (r = .275, p = .001). participants better understand patients’ social systems,
with other medical conditions demonstrated symptom experiences, adherence levels to
significant relationships with adherence and therapeutic regimens, and overall quality of
quality of life (r = .495, p = .002). This study life” (p. 342).
suggested that body dysmorphia, adherence
to ArV regimen, and diminished HrQOl Kenn M. Kirksey
are perceived as significant problems in Gayle McGlory