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Adherence and long-term treatment success

Published: 01 February 2009

Taking your HIV medication correctly (the technical term for this is adherence) is the single most important thing you can do to make sure your HIV treatment works well over the long-term.

Adherence above 95% has been the ‘gold standard’ ever since the publication of the landmark adherence study in 2000,1 which found that adherence above 95% was the level associated with the lowest risk of treatment failure in several past studies.

However, recently there has been conflicting evidence over just how critical it is for a person to maintain adherence above 95%.

Help with adherence

One of the questions we asked in NAM’s online treatment survey (the subject of our main article,The NAM treatment survey) was: “Please tell us about things that have helped you in taking HIV treatment.”

A quarter of respondents to the English survey (367 in all) chose to add comments at this point. (We haven’t yet translated the comments from the surveys in other languages.)

A number of factors were mentioned repeatedly as helping people adhere to their treatment. The most frequently mentioned idea was an alarm, most often a mobile phone alarm, that prompted people to take their pills: in fact, one in five respondents mentioned this as something they used.

Other things mentioned frequently were pill boxes, mentioned by one in ten respondents, and “one pill, once a day”, mentioned by one in twelve, over half of whom specifically named the efavirenz/tenofovir/FTC combination pill, Atripla. Another 18 people mentioned other once-daily regimens, making this the second-most cited aid to adherence.

One respondent combined both a pill box and Atripla: “I have a small plastic ‘bullet’ which holds my Atripla; it rattles with my body movement from time to time and reminds me if I haven’t taken the pill.”

Support from friends, family or partner was mentioned as important by 6% of respondents and the importance of a daily routine by 5%. “Just knowing I’ll die if I don’t” or variations on that theme was also an important motivation.

Other respondents used this space to give us little potted biographies or confessionals, which were sometimes very moving. Here are two examples of how and why people consciously choose to adhere to their treatment, day-in, day-out:

“I was an irresponsible single man when I became infected with HIV, I worked hard and partied harder. My diagnosis in 2002 changed my life entirely. I’ve now got a partner who is also positive and we help and support each other through the bad days. Drugs can keep you alive, but you have to believe it’s worth taking them first.”

“I think the love I have for life and my children encourages me to take them. I have young children and I would love to see them through their childhood and adulthood and get educated while I am alive. I don’t want to die now, when they are so young. Who will look after them if am not responsible enough to take my medication? I have a lot to live for.”

 

For more information and tips on adherence, visit NAMlife’s adherence pages.

References

  1. Paterson et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine 133(1): 21-30, 2000.

  2. Marin M Relationship between adherence level, type of antiretroviral regimen, and plasma HIV type 1 RNA viral load: a prospective cohort study. AIDS Research and Human Retroviruses 24: 1263-68, 2008.

  3. Lima V et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS 22: 2371-2380, 2008.

Issue 183: January/February 2009

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.