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  • Open Access

Complex comorbidity and adherence to therapy for chronic kidney disease: disease perceptions & adherence in patients with comorbid HIV

  • Marina Yostos1,
  • Christina Wyatt2 and
  • Ioannis Konstantinidis2
BMC Proceedings20159(Suppl 7):A20

Published: 27 October 2015


Chronic Kidney DiseaseIllness PerceptionCare SatisfactionMedication Event Monitoring SystemIllness Representation


In the light of an aging HIV population and improved HIV treatment, Chronic Kidney Disease (CKD) has become a common contributor to morbidity and mortality. Despite that the management of CKD in HIV patients is a growing priority, little is known about the impact of HIV infection on CKD therapy adherence [1]. To investigate adherence to CKD medications and antiretroviral (ARV) medications in patients with co-morbid HIV infection and CKD - in order to identify modifiable predictors of dual adherence, focusing on illness representation and medication beliefs.


This is a qualitative cross-sectional study that prospectively measures the relationship between disease perceptions and adherence using self-report instruments and the electronic Medication Event Monitoring System (MEMS).

HIV viral loads were used as surrogate markers to validate self-reported adherence to ARV medications. Depression, self-efficacy, alcohol and substance abuse and health literacy were assessed [2]. 20 well-characterized patients with CKD/ESRD and HIV were recruited. Institutional Review Board (IRB) approval was granted. Consent and confidentiality were protected under the Health Insurance Portability and Accountability Act (HIPAA).


(I) Demographics Data: Gender, language, ethnicity, race, education, income marital status and disease precedence did not affect adherence. Higher comorbidity and pill burden correlated with dual non-adherence. (II) Adherence Data: 65% of participants reported dual adherence, 15% reported mono-adherence and 20% reported non-adherence. ARV self-reported adherence correlated with viral load and CD4+ counts. (III) Barriers & Facilitators of Adherence: Higher self-efficacy, care satisfaction and trust in physician correlated with adherence. Depression, smoking, psychiatric illness, alcohol or substance abuse correlated with dual non-adherence. (IV) HIV & CKD Illness Perceptions: Negative disease perceptions such as stigma and guilt correlated with non-adherence. (V) Medication Beliefs: Negative medication beliefs were more prevalent among ARV non-adherent patients. Adherence was higher in patients that reported better understanding of disease and medication.


The majority of participants perceived CKD to be their main health concern possibly because CKD improvement requires a combination of lifestyle modifications and medication adherence [3].

Authors’ Affiliations

Royal College of Surgeons in Ireland, Dublin, Ireland
Mount Sinai Icahn School of Medicine, New York, USA


  1. Lay C, AHRQ: Medicines for Early Stage Chronic Kidney Disease: A Review of the Research for Adults With Kidney Disease and Diabetes or High Blood Pressure [homepage on the Internet]. 2012, AvailabMedicine University of Toronto, Web site: Scholar
  2. Chao J, et al: “The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes”. Res Social Adm Pharm. 2005, 1 (4): 508-525. 10.1016/j.sapharm.2005.09.002.PubMedView ArticleGoogle Scholar
  3. Leventhal H, Diefenbach M, Leventhal EA: Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research. 1992, 16: 143-163. 10.1007/BF01173486.View ArticleGoogle Scholar


© Yostos et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.