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Remember to Take Your Meds

HIV drug therapy adherence is critical

By Bruce Goldfarb | 12.09.2009
Originally Published January 2007
String around a finger

Adherence to drug therapy is critical to anyone with a chronic condition, but especially for people with bleeding disorders who also are infected with HIV.

Patient support that emphasizes practical drug management skills and individualized attention can promote adherence to therapy for HIV, according to a recent report.

Adhering to a drug regimen such as the highly active retroviral therapy (HAART) cocktail is “one of our most significant challenges in treating HIV,” says Adriana Andrade, MD, infectious disease specialist at the Johns Hopkins Medical Center in Baltimore, Maryland. “Patients are asked to take a combination of pills daily,” says Andrade. “Almost perfect adherence is necessary.”

Family physician Richard Glazier, MD, of St. Michael’s Hospital in Toronto, Canada, and colleagues reviewed 19 studies to identify strategies for adhering to HIV drug ­therapy.1

While the studies were too different for definitive conclusions, the researchers found that those with the best results were from programs that emphasized practical medicine management, featured one-on-one attention, or lasted 12 weeks or more.

Data that look at adherence to HIV therapy by people with hemophilia compared to people without bleeding disorders are not available. Some observers suggest that people who have managed a lifelong chronic condition are more likely to comply with the HAART therapy.

Simple forgetfulness is one of the most common reasons that a person fails to adhere to a drug regimen. Mild mental impairment can result from the effects of HIV on the brain, as well as from hepatitis C virus infection and other medical conditions.

Andrade and colleagues recently tested an electronic device that gives personalized text and voice reminders on 58 people with HIV who have mild mental impairment.

People who used the pagerlike device achieved a 77% adherence rate, compared to a 57% adherence rate for those who did not.2 Forgetfulness “is a very serious issue,” Andrade says. ‘We can overcome it by trying to come up with strategies to remind patients to take their medication.”

References

  1. Rueda S, et al. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochran Database of Systematic Reviews 2006; 3:CD001442.
  2. Andrade AS, et al. A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment. Clinical Infectious Diseases 2005; 41:875–882.