The psychosocial and medical intersection of HIV and epilepsy in Zambia

Human Immunodeficiency Virus (HIV) has transformed from a deadly disease to a chronic condition. As a result, the number of conditions occurring with HIV is increasing dramatically. In sub-Saharan Africa, epilepsy is the most common chronic neurological disorder. The probability that someone will have both HIV and epilepsy is substantial. In addition, new-onset seizure occurs in more than 10% of HIV-positive adults and people with epilepsy are more vulnerable to HIV infection than people without epilepsy. Little is known about the psychosocial and medical burden faced by people with both conditions.;HIV and epilepsy are associated with disease-associated stigma, however, it is unclear whether comorbid HIV and epilepsy is associated with increased reported stigma ("layered stigma"). To assess layered stigma, we first examined the measurement properties of the 24-item Stigma Scale of Epilepsy (SSE) to determine whether it more adequately captures stigma from the perspective of individuals with epilepsy than the commonly used 3-item Stigma Scale.;We found that the SSE assessed two underlying traits, whereas the 3-item Stigma Scale only assesses one, suggesting that the SSE may be a more complete measure of felt stigma. We then used the SSE, the HIV/AIDS Stigma Instrument---PLWA, and Jacoby's 3-item Stigma Scale to assess HIV-related stigma and epilepsy-associated stigma reported by people with HIV & epilepsy, people with epilepsy only, and people with HIV only. Comorbid HIV infection and epilepsy was associated with moderately increased HIV-related stigma. No significant differences in epilepsy-associated stigma were found. We then examined medication side effects to determine whether cotreatment with antiretroviral drugs (cART) for HIV and an enzyme-inducing antiepileptic drug (EI-AED) for epilepsy was associated with increased adverse events. As there is limited data regarding side effects from EI-AEDs prescribed routinely in resource-limited settings, we first assessed adverse events experienced by Zambian people with epilepsy taking a stable dose of phenobarbital. Participants reported a mean of five side effects, which suggests that phenobarbital is may not be as well tolerated as previous studies suggest. We then assessed adverse events reported by HIV-positive individuals initiating cART with an EI-AED and compared them to adverse events reported by individuals initiating cART only and individuals with untreated HIV infection. Adverse events were assessed again two weeks later for individuals initiating cART with an EI-AED and cART only. We found that, despite having a higher CD4+ T-cell count, individuals initiating cART and an EI-AED were generally more symptomatic at baseline than individuals in the other treatment groups. In addition, more participants in the cART+EI-AED group reported experiencing nausea or vomiting at follow up than at baseline using paired t-tests.;This dissertation quantified some of the medical and psychosocial challenges faced by people with HIV and epilepsy. Understanding these challenges is essential to providing optimal care to patients with comorbid HIV and epilepsy. Additional research examining layered stigma and medication adverse effects among people with comorbid HIV and epilepsy is warranted.