Les représentations de la maladie et des effets secondaires du traitement antirétroviral comme déterminants de l’observance chez les patients VIH

Abstract

One of the major axes of the current research in the field of HIV concerns the problems of adherence to the antiretroviral treatment (ART). It proves that a quasi-perfect adherence is necessary so that the treatment is effective. In this study, the authors studied one of the determinants of the adherence: the patient's representations relating to his/her disease, its treatment and its side effects. The self-regulation model proposed by Leventhal (1980) postulates that patients suffering from a chronic illness construct a representation of their disease containing several dimensions to give it sense. The impact of these dimensions on adherence to treatment was demonstrated in various chronic illnesses. In the field of HIV, two studies relate to this subject, but require to be deepened. Therefore, the authors set up a study to complete these data with 61 HIV patients under antiretroviral treatment recruited by means of the service of the infectious and tropical diseases of the hospital of Pitié-Salpêtrière in Paris. Illness representation and representation of treatment's side effects were evaluated using the self-administered questionnaire of illness representation: the IPQ-R (Revised Illness Perception Questionnaire [Psychol Health 17 (2002) 1–16]). Adherence to ART was evaluated using the self-administered questionnaire of adherence worked out by Tarquinio et al. [Rev Int Psychol Soc 2 (2000) 61–91] and revised by Gauchet [Les déterminants psychosociaux de l’observance thérapeutique chez les personnes infectées par le VIH : représentations et valeurs. Thèse de Doctorat non publiée. France: Université de Metz; 2005]. The results indicate that illness representation has an influence on adherence. Furthermore, HIV patients build a representation of the side effects which is different than the representation of symptoms attributed to the HIV. It turns out that the representation of personal control, the representation of the cause of contagion, as well as that of the side effects influence adherence to ART. These results indicate that the self-regulation model proposed by Leventhal provides a theoretical base to understanding the behavior of coping with illness in the case of HIV. Moreover, they give arguments in favour of the implementation and of the evaluation of the efficiency of behavioral and cognitive therapies or therapies of counseling to increase adherence of HIV patients.