A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy

Abstract

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 1,557 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.

Development and initial validation of a cessation fatigue scale

“…While several reviews have described treatment burden among those with a range of chronic medical conditions (Eton et al, 2013; Gallacher et al, 2013a; Gallacher et al, 2013b), examining the psychological impact of that burden (i.e., treatment fatigue), is a growing area of interest. This has been done primarily in the diabetes (Fritschi and Quinn, 2010; Pyatak et al, 2013) and HIV literature (Claborn et al, 2015a, 2015b; Miramontes, 2001). In both disease populations, treatment fatigue was highest among those with more intensive treatment and experience of treatment complications (e.g., side effects), and was associated with negative outcomes including emotional distress, lower quality of life, and reduced treatment adherence.…”

Treatment burden and treatment fatigue as barriers to health

“…A systematic review identified 17 studies that addressed fatigue associated with chronic disease management among people living with HIV [22]. To consolidate the vast terminology (e.g., pill-, medication-, treatment-, regimen-, dosing-, drug-, and injection-fatigue), the authors recommended future use of treatment regimen fatigue, which they defined as decreased desire and motivation to maintain vigilance adhering to prescribed treatment regimens.…”

Initial Validation of the HIV Treatment Regimen Fatigue Scale for Adults Prescribed Antiretroviral Therapy

“…In addition to showing developmental effects, treatment regimen fatigue appears to occur episodically throughout the course of treatment and varies in intensity and severity, which may serve as a potential mechanism to changes in adherence over time (Claborn et al, 2014). Unfortunately, this barrier to adherence has received minimal attention in the literature; therefore, additional research regarding its etiology, symptomatology, maintenance, and potential mechanisms of intervention and prevention is warranted.…”

“…Recent qualitative evidence suggests that these factors may also comprise the construct of treatment regimen fatigue, which has been defined as a “decreased desire and motivation to maintain vigilance in adhering to a treatment regimen as prescribed by a provider” (Claborn, Meier, Miller, & Leffingwell, 2014, p. 7) and “a waning commitment to continue with the prescribed treatment” (Crawford, Jewell, Mara, McCatty, & Pelfrey, 2014, p. 1093). Treatment regimen fatigue has recently been identified among several chronic illness populations including diabetes, multiple sclerosis, and HIV (Claborn et al, 2014; Crawford et al, 2014; Pyatak, Florindez, & Weigensberg, 2013). …”