Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

Adherence to medication: adherence to Highly Active Antiretroviral Therapy

G. Friedland
Yale University School of Medicine, New Haven, Connecticut, USA

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL1.3
AIDS 2000, Oct 22-26;14(Suppl. 4);S1

Highly Active Antiretroviral Therapy (HAART) has dramatically altered the natural history of HIV disease. Even for those with access to HAART, biologic, behavioral, clinical and public health realities have blunted their full benefit. Among these, acceptance and adherence to antiretroviral therapy has emerged as central to therapeutic outcome in both clinical care and clinical trial settings. Adherence with antiretroviral medications is felt to be a crucial component in maintaining therapeutic drug levels, ensuring viral suppression and reducing risk of drug resistance. Nevertheless, under-appreciation of the role of adherence in treatment failure remains.

Regardless of measurement technique, emerging data supports the direct correlation of adherence to levels of decline in viral load and elevations in CD4 cell parameters and, more recently, with clinical outcomes including rates of hospitalization, AIDS progression and mortality from HIV disease. Further, it appears that required levels of adherence to achieve acceptable therapeutic outcome are higher in HIV disease than other chronic diseases. In some studies, very high levels of adherence (>90%) to protease inhibitors were needed for acceptable virologic suppression and small differences in adherence levels were associated with substantial differences in virologic outcome. Finally, emerging longitudinal data indicate that adherence may decline over time.

The correlates of adherence to HIV medications have been elucidated in an array of studies and include characteristics of the patient, provider of care, regimen, disease status and clinical setting. Based upon these, many strategies for improving adherence have been proposed including assessing readiness to begin therapy, provision of information, enhancement of motivation including the identification and treatment of depression and substance abuse and the provision of medication behavioral skills. In addition, simplification of treatment regimens, and the reduction of side effects and toxicities has been fostered. However, few carefully constructed and rigorously evaluated clinical trials of practical interventions to improve adherence have been successfully carried out. Such studies are greatly needed to help inform therapeutic strategies if the full benefits of HAART are to be fully realized and sustained over time.

Presenting author: G. Friedland

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2000-10-22
PL1-3

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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