"A" Is for Adherence
December 2001/January 2002
Maintaining adherence to medication is vital for sustaining viral suppression.
Adherence to HIV medications is not easy. After deciding to take medications, one must address and overcome challenging barriers.
Researchers report that in order for HIV medications to effectively reduce viral load, raise T-cells and improve overall immune system function, they must be taken at a consistency rate of 95 percent or higher.
A medication regimen of Sustiva and Combivir requires five pills daily: one in the morning and four at night. In a 30-day month, this totals 150 pills. Ninety-five percent of this total is 143. This means missing more than seven pills in a month may render the medication ineffective.
There are common reasons for missing medications. Some people lose track of time because they are busy with other activities. Others may wish to avoid side effects of the medications, which may include nausea, headaches, rash and diarrhea. Lastly, some people are tired of taking pills on a daily basis. As stated earlier, the consistency with which HIV medications must be taken is unforgiving.
There are other reasons reported for not taking medications as prescribed: Some people state that they are too busy to fit medication regimens into their routines; some choose not to take their medications because they are too happy and do not want to terminate feelings of elation; others are too depressed and do not want to be reminded of their illness two times each day; and yet others do not take their medications because they do not have the necessary foods needed for successful drug absorption.
Treatment advocates have a unique opportunity to offer useful techniques to increase medication adherence for people with HIV disease.
Often, treatment advocates or peer educators are people who are also living with HIV and may offer personal experience and insight. Traditional methods suggested by treatment advocates, such as placing pill containers in frequently used areas, or taking medications at 12-hour intervals, have proved successful. Taking medications during favorite television shows, during breaks at work or before or after dinner, placing notes on a refrigerator, or enlisting the help of friends to place a timely phone call, are all suggestions that treatment advocates have employed when helping people to adhere to medication regimens.
For those who take several types of HIV medications, treatment advocates often suggest writing in diaries. Diaries can also be a great resource for people to use as a history of side effects when speaking with a health care provider.
Pharmaceutical companies and pharmacies (both local and mail-order) also offer plausible suggestions. Several pharmaceutical companies have designed daily, weekly and monthly pillboxes where medications can be easily stored. Pillboxes are typically labeled by day, morning and evening and many times are in Spanish as well. These containers allow people the opportunity to save time by placing pills in the boxes on a monthly or weekly basis.
The Arpex Corp. has developed an electronic monitoring system that records the date and time when the bottle is opened. The Medication Event Monitoring System, or MEMS cap, has an embedded microchip. In studies, MEMS cap bottles have shown a strong correlation with adherence to medications and lower viral load results.
Researchers are also studying the effects of Directly Observed Therapy (DOT) and adherence to medications. DOT refers to a person taking medications while being observed by a volunteer who records whether or not the person takes the medication.
Preliminary results from a DOT study at AIDS Healthcare Foundation have shown that participants are more adherent to their medications and have had a reduction in viral load. However, once the six-week study was completed, most participants were less adherent to their medication regimens and required more assistance.
When taking HIV medications, maintaining a sufficient amount of medication within the body for viral suppression is crucial. When the drug level is too low, resistance may occur.
Resistance refers to the ability of the virus to mutate in such a way that the new virus it produces is no longer susceptible to the medication that is in the body. For instance, if medication that must be taken twice daily is only taken once a day, then the level or amount of drug necessary to stop HIV replication will not be present.
HIV infection is not yet a manageable disease. However, conscientiously taking medications as prescribed may assist people in suppressing the virus for longer periods of time.
This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.