Pain and Medication Adherence in Adult Smokers Living with HIV: A Cross-Sectional Observational Study

Abstract

Introduction: Medication adherence in persons living with HIV (PLWH) is vital for suppression of viral load. Unfortunately, nonadherence to antiretroviral medications is common in PLWH. Both pain and psychiatric symptoms occur frequently in PLWH and are associated with decreased medication adherence in other chronic diseases. As such, pain and psychiatric symptoms may represent modifiable variables which influence adherence in PLWH. The present study examines the relationship between pain, psychiatric symptoms, and medication adherence in PLWH who smoke. Methods: This was a secondary analysis of data originally collected for a study of smoking in PLWH. Sixty-eight adult HIV-positive smokers taking antiretroviral medication were recruited from the Center for Positive Living clinic in the Bronx, NY. Participants completed a survey with measures including the Morisky Medication Adherence Scale (MMAS-8), PROMIS scales for anxiety, depression, and pain interference, the Neuropathic Pain Questionnaire (NPQ), the Numeric Rating Scale (NRS) for pain severity, and a single item measuring symptom-related distress. Results: The presence of pain, OR = 3.81, 95% CI [1.19, 12.14], higher pain severity in the past seven days, OR = 1.22, 95% CI [1.05, 1.41], higher symptom-related distress, OR = 2.18, 95% CI [ 1.24, 3.83], and higher anxiety in the past seven days OR = 1.09, 95% CI [ 1.03, 1.14] were associated with inferior medication adherence (MMAS-8 score < 6). Both symptom-related distress ab = .56, BCa CI [0.06, 1.51] and anxiety ab = .56, BCa CI [0.05 1.61] mediated the relationship between the presence of pain and medication adherence. Only anxiety mediated the relationship between pain severity and medication adherence ab = .09, BCa CI [0.01 0.24]. Conclusions: The results of this study suggest that pain and psychiatric symptoms are factors that significantly contribute to medication nonadherence and thus are important areas of assessment by clinicians treating adult smokers living with HIV.