HIV and Adherence

“Treatment adherence” is a term that means taking one’s HIV drugs when and how one is supposed to. Treatment adherence means following the treatment regimen closely every day, taking the correct dose of each anti-HIV medication at the correct time and exactly as prescribed.

Treatment adherence is extremely important because it affects how well the HIV medication decreases the viral load. The lower the viral load, the healthier one is likely to be.

Adherence also helps to prevent drug resistance. If a dose of medication is missed, even once, the virus can take that opportunity to replicate, and make more HIV. When doses are skipped, one may develop strains of HIV that are resistant to the medications currently being taken, and possibly even to medications that haven’t been taken yet. If this happens, it could leave the individual with fewer treatment options.

There are many different anti-HIV medications and treatment regimens, but studies show that a person’s first regimen offers the best chance for long-term treatment success. Good adherence from the start is key to successful treatment. Before one begins an HIV treatment, there are several steps one can take to help with adherence:

• Talking with healthcare providers about your treatment plans and developing a suitable plan for the individual.
• An understanding about why adherence is so important and the possible consequences of non-adherence will provide a motivation to stick with the plan.
• Get a written copy of the treatment plan that lists each medication and describes how and when to take them.
• Learn all the possible side effects of the medications so that one knows what to expect and how to manage any problems.
• Adherence can be harder if one is dealing with life challenges, like substance abuse/alcoholism, unstable housing, mental illness, relationship issues, or other issues. One should talk to their healthcare provider about any challenges that could affect their ability to take HIV medication.
• A dry run should be considered using sweets or vitamins to practice the treatment regimen.
• Scheduling the taking of medication around daily routines. That can make it easier to remember and sticking to the regimen.
• Medication should be taken at the same time each day and kept it in the same place. Computer or cell phones can be used to send an automatic reminder to take the required medication.
• At the beginning of each week, medication should be put in a pill organizer box. (Boxes that have compartments for different time periods for each day of the week.) The organiser can be used to adjust for possible changes in routine, like holidays, vacations, etc. Doing this will help you keep track of which medication has been taken.
• Lack of health insurance or funds to pay for medication also may provide an obstacle to adherence, This should be discussed with the healthcare provider concerned. 
• Supply of medication needs to be monitored. The healthcare provider or clinic needs to be contacted if the supply will not last until the next visit.

Keeping on track with HIV adherence is about more than just staying on schedule with the prescribed medication. The healthcare providers have an overall plan, which includes medical appointments, dental appointments, lab tests, and many other services. People can fall out of care for many of the same reasons they find it find it hard to take their medication.

Travel, work, school, family, friends, substance abuse, mental illness, housing, and many other life events and stresses can all have an effect on whether or not one can make it in to the clinic on a particular day.

Clinicians and healthcare providers understand that life happens and no one is going to be perfect 100% of the time. Everyone will miss an appointment from time to time. But falling out of care can really damage one’s health, so it’s important that individuals take the initiative to follow up and stay involved in their adherence and care.

(This column is authored by Dr Avron Urison, Medical Director at AllLife Pty Ltd – providers of life insurance for HIV positive individuals.)