Seventh International Congress on Drug Therapy in HIV Infection Glasgow, UK - 14-17 November 2004

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL5.1

Rainer Weber
Division of Infectious Disease & Hospital Epidemiology, University Hospital, Zurich, Switzerland

Adherence to antiretroviral therapy is among the most important prerequisites for treatment success. (1) Decreased adherence is associated with virological failure, clinical progression and death. To achieve and maintain complete suppression of viral replication, adherence of above 90-95% is required, but the minimum threshold of adherence necessary for the clinical effectiveness remains unclear. (2) Adherent persons with complete viral suppression are less likely to develop virological failure associated with viral resistance. However, among patients with ongoing viral replication increasing adherence may result in the emergence of drug resistance. (3) Adherence assessment using technical means, including pill counts, electronic medication exposure monitoring system (MEMS), or plasma drug level monitoring, provide objective data, but are often not applicable, accepted or available in long-term patient care. The lack of sensitivity of self-reports may be improved using validated adherence questionnaires. An estimation of adherence by care providers is a non-valid method. (4) Numerous predictors of adherence have been recognized, including physician-patient communication, organization of care settings, demographic and behavioural patient characteristics, and mode of drug regimens. However, individual non-adherence cannot be predicted a priori on the basis of a few patient characteristics. Instead, anticipation of and dialogue on the impact of drug regimens on patients' daily live, management of short-term and long-term toxicities and support in the routinization process of daily drug intake can improve patient care. (4) A fundamental precondition for treatment success is the patient's motivation. Intervention strategies to improve adherence include cognitive-behavioural methods, behavioural strategies, directly observed therapy, and affective strategies. In resource-limited settings adherence can be achieved by strengthening community-based efforts. In summary, monitoring adherence and promoting tailored socio-behavioural support is an integral part of antiretroviral therapy and patient care.

SESSION 5: ADHERENCE, RESISTANCE, CLINICAL PHARMACOLOGY AND DISEASE MONITORING

2004-11-14
PL5.1

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