HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV.

OBJECTIVES: Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences. METHODS: HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities. RESULTS: Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01). CONCLUSIONS: Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.

Reproductive assistance to HIV-discordant couples--the German approach.

An estimated 35 000 Germans are infected with HIV, and 75% of these are of childbearing age. Couples with one infected partner are faced with the risk of infection of the healthy partner. By using assisted reproduction techniques (ART) and virus-free sperm it is possible to fulfil the desire for children while minimising the risk of acquisition of infection. Therefore since 1991 in Germany ART is offered to couples of HIV-positive males and seronegative females. However, established programmes in different centres were temporarily suspended due to serious doubts about the reliability and safety of the sperm preparation technique (density gradient centrifugation and swim-up). -. Since 1997 processed sperm samples are routinely tested for HIV by highly sensitive detection methods and cryopreserved. Only if the test is negative are the processed spermatozoa used for homologous insemination, in-vitro fertilization or intracytoplasmatic sperm injection. This procedure removes most medical as well as legal considerations. At present 3 reproductive units in Germany offer reproductive assistance to HIV-discordant couples, and a further 9 institutions plan to establish that procedure. From 1991 to 1999, 54 women were treated by ART. 30 pregnancies occurred and 24 children were born. So far no maternal or infant infection was observed after treatment.

Diagnostics and treatment of HIV-discordant couples who wish to have children.

Over the last years the reality surrounding HIV-infection has undergone a considerable change with regard to the life expectancy of patients, and the plans they can make for their lives. Because the majority of the HIV positive population is of reproductive age, one of these plans might be to have children, often as an expression of a fulfilled partnership. The need for medical support to realize this wish, however, is often confronted with ethical, medical or forensic restraints. For this reason, interdisciplinary recommendations have now been developed--for the first time on a global basis--which aim to provide guidelines for practitioners in this complicated area.