Abstract
In our perinatal HIV cohort, we have observed difficulty swallowing pills as a frequent and significant barrier to adherence to highly active antiretroviral therapy. We refer to this problem as pill aversion and define it as difficulty swallowing pills with no persistent medical or structural cause as well as the anxiety and physical symptoms associated with pill swallowing. By applying cognitive behavioral theory to behavioral patterns within our pregnant HIV-infected population, we seek to better understand the development and reinforcement of pill aversion behavior. On the basis of this theory, our experience, and the pediatric pill-swallowing literature, we propose a conceptual framework for understanding the multiple causes of pill aversion and applying therapeutic interventions to a perinatal population. In a theoretical discussion, we address the roles of classical conditioning and cognitive theory in the development and experience of pill aversion in an HIV-infected pregnant population. We propose future steps for characterizing these behaviors and testing theories and interventions.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Paterson DL, Swindells S . Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133 (Suppl. 1): 21–30.
Mannheimer S, Friedland G, Matts J, Child C, Chesney M . The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis 2002; 34: 1115–1121.
McNabb J, Ross JW, Abriola K, Turley C, Nightingale CH, Nicola DP . Adherence to highly active antiretroviral therapy predicts virologic outcome at an inner-city human immunodeficiency virus clinic. Clin Infect Dis 2001; 33: 700–705.
Ickovics JR, Cameron A, Zackin R, Bassett R, Chesney M, Johnson V et al. Consequences and determinants of adherence to antiretroviral medication: results from adult AIDS Clinical Trials Group protocol 370. Antivir Therapy 2002; 7: 185–193.
AIDSinfo and U.S. Department of Health and Human Services Office of AIDS Research Advisory Council. Panel on treatment of HIV-infected pregnant women and prevention of perinatal transmission: Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States 2014 Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. (accessed on 20 January 2015).
Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338 (13): 853–860.
Walensky RP, Paltiel AD, Losina E, Mercincavage LM, Schackman BR, Sax PE et al. The survival benefits of AIDS therapy in the United States. J Infect Dis 2006; 194 (1): 11–19.
Johnston V, Cohen K, Wiesner L, Morris L, Ledwaba J, Fielding KL et al. Viral suppression following switch to second-line antiretroviral therapy: associations with nucleoside reverse transcriptase inhibitor resistance and subtherapeutic drug concentrations prior to switch. J Infect Dis 2014; 209 (5): 711–720.
Cooper ER, Charurat M, Mofenson L, Hanson CI, Pitt J, Diaz C et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1 infected women and prevention of perinatal HIV-1 transmission. J AIDS 2002; 29 (5): 484–494.
Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, VanDyke R, Bey M, Shearer W, Jacobson RL et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with treatment zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331 (18): 1173–80.
European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005; 40: 458–65.
Lind CD . Dysphagia evaluation and treatment. Gastroenterol Clin N Am 2003; 32: 553–575.
Meltzer EO, Welch MJ, Ostrom NK . Pill swallowing ability and training in children 6 to11 years of age. Clin Pediatrics 2006; 45: 725–33.
Sallows GO . Behavioral treatment of swallowing difficulty. J Behav Therapy Exp Psychiatry 1980; 11: 45–47.
Garvie PA, Lensing S, Rai SN . Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV/AIDS. Pediatrics 2007; 119: 893–899.
Wendt GR . Review of Pavlov and his school: the theory of conditioned reflexes. Psychol Bull 1938; 35: 564–565.
Razran G . Extinction re-examined and re-analyzed: a new theory. Psychol Rev 1956; 63: 39–52.
Beck AT . Thinking and depression: theory and therapy. Arch Gen Psychiatry 1964; 10: 561–571.
Dobson KS . Handbook of Cognitive Behavioral Therapies 3rd edn New York: Guilford Press, 2009.
Cannon W . Wisdom of the Body. W.W. Norton & Company: United States, 1932.
Gleitman H, Fridlund AJ, Reisberg D . Psychology 6th edn W.W. Norton & Company, 2004.
Benson H . The Relaxation Response. Morrow: New York, 1975.
Goodwin TM . Nausea and vomiting of pregnancy: an obstetric syndrome. Am J Obstet Gynecol 2002; 186: S184–S189.
Richter JE . Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin N Am 2003; 32: 235–261.
Roden DF, Altman KW . Causes of dysphagia among different age groups. Orolaryngol Clin N Am 2013; 46: 965–987.
Claxton AJ, Cramer J, Pierce C . A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23: 1296–1310.
Graney MJ, Bunting SM, Russell CK . HIV/AIDS medication adherence factors: inner-city clinic patients’ self-reports. J Tennessee Med Assoc 2003; 96: 73–78.
Acknowledgements
This work was supported by the Evergreen Foundation of Northwestern Memorial Hospital under the Evergreen Invitational Grand Prix Foundation, as well as Northwestern University Feinberg School of Medicine. LMY was supported by NICHD 2K12HD050121-11.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Dorman, R., Yee, L. & Sutton, S. Pill aversion in HIV-infected pregnant women: Theory to practice. J Perinatol 37, 215–219 (2017). https://doi.org/10.1038/jp.2016.176
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2016.176
This article is cited by
-
The Psychological Impacts of Pill Dysphagia: A Mixed Methods Study
Dysphagia (2024)