The Role of Adherence to Antiretroviral Therapy in the Management of HIV Infection

Despite multiple studies demonstrating the relation between the success of highly active antiretroviral therapy (HAART) and adherence, inadequate adherence continues to be one of the most frequent reasons for poor treatment outcomes and/or lack of sustained treatment benefits. Interventions targeting patient-related social and psychologic barriers to adherence and issues related to mental health and substance abuse and access to health care may ameliorate their negative impact on adherence. Specific drug-related factors that influence adherence such as pill burden, dosing frequency, food requirements, and acute tolerability and safety concerns, however, are further issues that must be considered to optimize adherence. Fortunately, the availability of once-daily and coformulated agents with simple dosing requirements may help to improve adherence, and thereby make the difference between success and failure of HAART for some patients. A better understanding of adherence and its determinants and how to define specific goals in a given clinical setting are keys for clinicians to become more effective partners with patients in the achievement and maintenance of long-term virologic suppression and, more importantly, long-term health.

[1]  Gregory Makoul,et al.  Literacy, self-efficacy, and HIV medication adherence. , 2007, Patient education and counseling.

[2]  B. Gazzard,et al.  Better maintained adherence on switching from twice‐daily to once‐daily therapy for HIV: a 24‐week randomized trial of treatment simplification using stavudine prolonged‐release capsules , 2005, HIV medicine.

[3]  M. Wolf,et al.  Relation between literacy and HIV treatment knowledge among patients on HAART regimens , 2005, AIDS care.

[4]  B. Yip,et al.  Discordant Immunologic and Virologic Responses to Highly Active Antiretroviral Therapy Are Associated With Increased Mortality and Poor Adherence to Therapy , 2005, Journal of acquired immune deficiency syndromes.

[5]  R. Remien,et al.  Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: findings from the Healthy Living Project. , 2003, AIDS patient care and STDs.

[6]  C. Porter,et al.  A 2-Arm, Randomized, Controlled Trial of a Motivational Interviewing-Based Intervention to Improve Adherence to Antiretroviral Therapy (ART) Among Patients Failing or Initiating ART , 2006, Journal of acquired immune deficiency syndromes.

[7]  B. Gazzard,et al.  Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study , 2004, The Lancet.

[8]  M. Swartz,et al.  Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events. , 2006, AIDS patient care and STDs.

[9]  K. Nokes,et al.  Using a telephone support group for HIV-positive persons aged 50+ to increase social support and health-related knowledge. , 2003, AIDS patient care and STDs.

[10]  J. Frampton,et al.  Efavirenz/emtricitabine/tenofovir disoproxil fumarate: triple combination tablet. , 2006, Drugs.

[11]  D. Podzamczer,et al.  A Once-Daily Lopinavir/Ritonavir-Based Regimen Provides Noninferior Antiviral Activity Compared With a Twice-Daily Regimen , 2006, Journal of acquired immune deficiency syndromes.

[12]  Richard D Moore,et al.  Directly administered antiretroviral therapy in the treatment of HIV infection: benefit or burden? , 2002, AIDS patient care and STDs.

[13]  K. Tashima,et al.  Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. , 1999, The New England journal of medicine.

[14]  Joel E Gallant,et al.  Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. , 2004, JAMA.

[15]  B. Conway,et al.  Directly observed therapy for the management of HIV-infected patients in a methadone program. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  Mark A van de Wiel,et al.  Mortality and progression to AIDS after starting highly active antiretroviral therapy , 2003, AIDS.

[17]  P. Cahn,et al.  Abacavir Once or Twice Daily Combined With Once-Daily Lamivudine and Efavirenz for the Treatment of Antiretroviral-Naive HIV-Infected Adults: Results of the Ziagen Once Daily in Antiretroviral Combination Study , 2005, Journal of acquired immune deficiency syndromes.

[18]  C. Farthing,et al.  Once-daily versus twice-daily lamivudine, in combination with zidovudine and efavirenz, for the treatment of antiretroviral-naive adults with HIV infection: a randomized equivalence trial. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  A. Mocroft,et al.  Reasons for stopping antiretrovirals used in an initial highly active antiretroviral regimen: increased incidence of stopping due to toxicity or patient/physician choice in patients with hepatitis C coinfection. , 2005, AIDS research and human retroviruses.

[20]  D. Bangsberg,et al.  Modeling the HIV protease inhibitor adherence-resistance curve by use of empirically derived estimates. , 2004, The Journal of infectious diseases.

[21]  G. Moyle.  The Assessing Patients’ Preferred Treatments (APPT-1) study , 2003, International journal of STD & AIDS.

[22]  Richard D Moore,et al.  Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  P. Morlat,et al.  Simplification therapy with once-daily emtricitabine, didanosine, and efavirenz in HIV-1-infected adults with viral suppression receiving a protease inhibitor-based regimen: a randomized trial. , 2005, The Journal of infectious diseases.

[24]  Joel E Gallant,et al.  Tenofovir DF, emtricitabine, and efavirenz vs. zidovudine, lamivudine, and efavirenz for HIV. , 2006, The New England journal of medicine.

[25]  T. Tugenberg,et al.  Paradoxical effects of clinician emphasis on adherence to combination antiretroviral therapy for HIV/AIDS. , 2006, AIDS patient care and STDs.

[26]  M. Wolf,et al.  Social stigma concerns and HIV medication adherence. , 2006, AIDS patient care and STDs.

[27]  Ingrid A. Beck,et al.  A proof-of-concept study of short-cycle intermittent antiretroviral therapy with a once-daily regimen of didanosine, lamivudine, and efavirenz for the treatment of chronic HIV infection. , 2004, The Journal of infectious diseases.

[28]  Joseph Quinn,et al.  Overview of the effectiveness of triple combination therapy in antiretroviral-naive HIV-1 infected adults , 2001, AIDS.

[29]  N. Schneiderman,et al.  To take or not to take: decision-making about antiretroviral treatment in people living with HIV/AIDS. , 2006, AIDS patient care and STDs.

[30]  P. Grant,et al.  The effect of a multidisciplinary program on HAART adherence. , 2006, AIDS patient care and STDs.

[31]  H. Sørensen,et al.  ‘Simply forgot’ is the most frequently stated reason for missed doses of HAART irrespective of degree of adherence , 2006, HIV medicine.

[32]  P. Harrigan,et al.  The Impact of Adherence on CD4 Cell Count Responses Among HIV-Infected Patients , 2004, Journal of acquired immune deficiency syndromes.

[33]  N. Schmidt,et al.  Association between ancillary services and clinical and behavioral outcomes among HIV-infected women. , 2001, AIDS patient care and STDs.

[34]  Susan Swindells,et al.  Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection , 2000, Annals of Internal Medicine.

[35]  R. D. Bruce,et al.  Impact of Enhanced Services on Virologic Outcomes in a Directly Administered Antiretroviral Therapy Trial for HIV-Infected Drug Users , 2006, Journal of acquired immune deficiency syndromes.

[36]  J. Cramer,et al.  A systematic review of the associations between dose regimens and medication compliance. , 2001, Clinical therapeutics.

[37]  Julio S. G. Montaner,et al.  Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4+ Cell Count Is 0.200 to 0.350 109 cells/L , 2003, Annals of Internal Medicine.