Adherence to Antiretroviral Therapy

Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J (1999) Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 13 1763—1769. 

Castro A (2005) Adherence to Antiretroviral therapy Merging the clinical and social course of AIDS. PLoS Med 2 e338. 

Rodriguez-Rosado R, Jimenez-Nacher I, Soriano V, Anton P, Gonzalez-Lahoz J (1998) Virological failure and adherence to antiretroviral therapy in HIV-infected patients [letter]. AIDS 12 1112-1113. 

Rosenblum, M., S.G. Deeks, M.J. van der Laan, and D.R. Bangsberg. The risk of viro-logic failure decreases with duration of HIV suppression, at greater than 50% adherence to antiretroviral therapy. PLoS One, 4(9) e7196, 2009. doi 10.1371/ joumal.pone.0007196. 

Horvath, T., Azman, H., Kennedy, G. E., and Rutherford, G. W., Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection, Cochrane Database Syst Rev Mar 14 3 CD009756,2012. 

Highly Active Antiretroviral Therapy (HAART) HAART slows or inhibits reverse transcriptase and protease enzymes by using several antiretroviral agents. HAART decreases the viral load. The viral load measures the amount of virus in the body. A decreased viral load causes an increase in CD4+ T cells and results in the immune system being able to identify, neutralize, and destroy non-self-cells. HAART therapy must be adhered to because the virus can become resistant to the antiretroviral agents. The patient must also adhere to nutritional therapy and avoid infections. 

Singh N, Berman SM, Swindells S, et al. Adherence to human immunodeficiency virus-infected patients to antiretroviral therapy J Infect Dis 1999 29 824-830. 

The patient must adhere to HAART therapy as the virus becomes resistant and the antiretroviral agents lose their therapeutic effect. In addition, patients must avoid opportunistic infections and aggressive prophylaxis and treatment of opportunistic infections that do occur is recommended. Nutritional therapy, complementary therapy, and supportive care are also necessary. 

Treatment considerations for antiretroviral-experienced patients are much more complex than for patients who are naive to therapy. Prior to changing therapy, the reasons for treatment failure should be identified. A comprehensive review of the patient s severity of disease, antiretroviral treatment history, adherence to therapy, intolerance or toxicity, concomitant drug therapies, co-morbidities, and results of current and past HIV resistance testing should be performed. If patients fail therapy due to poor adherence, the underlying reasons must be determined and addressed prior to initiation of new therapy. Reasons for poor adherence include problems with medication access, active substance abuse, depression and/or denial of the disease, and a lack of education on the importance of 100%... 

Andrade AS, McGruder HF, Wu AW, Celano SA, Skolasky RL, Seines OA, Huang IC, McArthur JC (2005) A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment. Clin Infect Dis 41 875-882. 

Although virologic failures have been uncommon in clinical trials of raltegravir to date, in vitro resistance requires only a single point mutation (eg, at codons 148 or 155). The low genetic barrier to resistance emphasizes the importance of combination therapies and of adherence. Integrase mutations are not expected to affect sensitivity to other classes of antiretroviral agents. 

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