Helping patients adhere to therapy

Adherence refers to how well a patient follows his or her treatment regimen. Helping patients adhere to an HIV drug treatment regimen is extremely challenging. Adherence is a major issue in HIV treatment for two reasons:

1. Adherence affects how well anti-HIV medications decrease the viral load and increases the chance of success. When patients skip even one dose of medication, HIV has the chance to reproduce more quickly. Keeping HIV replication at a minimum is essential for preventing AIDS-related conditions and death. Some HIV drug regimens require more than 20 pills a day. Patients must take 95% percent of their drugs to achieve an 80% likelihood of HIV suppression below undetectable levels. If patients take less than 95% of their prescribed drugs, the chance of success drops below 50%.

2. Strict adherence to HIV treatment helps prevent drug resistance. When patients skip doses, strains of HIV that are resistant to drugs can develop. This may leave patients with fewer treatment options. Although there are many different anti-HIV medications and treatment regimens, studies show that the first regimen has the best chance for long-term success. In addition, not taking HIV drugs regularly and reliably causes the virus to be exposed to less-than-expected drug serum concentrations. This drastically increases the chance that drug resistance will develop.

Health care professionals can help increase HIV drug adherence by:

• Educating the patient about the goals of therapy and the importance of complying with the regimen./li>
• Anticipating and treating side effects.
• Reducing the dosage frequency and number of pills, if possible.
• Enlisting the support of the patient’s family and friends.
• Providing a written dosing schedule, pictures of medications, daily or weekly pillboxes, alarm clocks, pagers, or other reminders.
  

Compliance with HIV therapy is difficult for many people, especially those who are ill or are experiencing negative drug side effects, such as skin rashes, nausea, and diarrhea. Other factors that can be barriers to compliance include traveling away from home, a busy work or home schedule, depression, and forgetting to take medications.

It is also important to remind patients that even when the drugs "are working", or their viral load is low, they can still infect other people with HIV.

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