New study findings suggest that HIV-positive patients who believe they will live for many years are more likely to miss medication doses and to not practice safe sex than their peers who are less hopeful. Optimism can often help patients cope with a medical condition; but these findings indicate that in the context of HIV, there can be negative consequences to a positive outlook, according to Drs. William C. Holmes and Joseph L. Pace of the University of Pennsylvania-Philadelphia.

The authors surveyed 220 HIV-positive people about their backgrounds, disease history, attitude about their illness and health behaviors. The investigators found that people were more likely to use negative words about being HIV-positive when they were first diagnosed than at the time they completed the surveys. Most of the patients said they thought they would live for many years, and 27 percent said they expected to reach old age. White respondents, those with less education, and patients with relatively low levels of CD4 cells were less likely to hold out hope for the future.

Those patients who said they were relatively optimistic about the future were twice as likely as those with relatively pessimistic outlooks to sometimes forget to take their medications, and they were almost twice as likely to report not practicing safe sex. About 26 percent of optimists and 13 percent of pessimists occasionally forgot to take their medications; 57 percent of optimists and 29 percent of pessimists said they did not always practice safe sex.

In an interview, Holmes said people who are optimistic about the future may become less concerned with the importance of regimen adherence and safe sex. To keep patients optimistic and still safe and healthy, clinicians should educate their patients about the possible negative consequences of good cheer. "Anticipatory discussions with patients can act to help them develop insight about and vigilance against these potential problems," he said.

The full report, "HIV-Seropositive Individuals' Optimistic Beliefs About Prognosis and Relation to Medication and Safe Sex Adherence" was published in the September issue of the Journal of General Internal Medicine (2002;17:677-683).

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