Multiple studies have demonstrated that HIV treatment regimens (especially those combining multiple drugs) work most effectively when taken at the prescribed time and quantity. Furthermore, if the levels of medications in the body aren't kept high, the HIV virus has a chance to reproduce. This is bad for two reasons:
- The virus will multiply within the body. This will only worsen he infection.
- Every time the virus replicates, small changes occur within its RNA. These changes, also known as mutations, can render some anti-viral drugs ineffective. Thereby forcing a change in medications.
However, it is very hard to stay on the prescribed dosing schedule because some medicines must be taken at different intervals than others. To make the situation even worse, some drugs must be taken without food in the stomach, and still other drugs must be taken with food. On top of that, almost all HIV medications have specific storage, and/or preparation conditions that must be met in order to prevent the drug from degrading, and becoming useless. Furthermore, the multitudes of drugs ingested can cause unpleasant side effects such as diarrhea and depression.
Complicating matters more is the busy schedule in everyday life. Sometimes, the patient may forget to take the medicine, or take it with food when the drug has to be taken on an empty stomach. It is all too easy to forget when the last dosage was. Fortunately, there are alarm watches, pill organizers, and beepers to help keep track of the confusing jumbles of pills and capsules.
Perhaps the greatest reason for patients not wanting to take their medications is that to do so is a constant reminder of their HIV infection and the surrounding social stigma. Since pills are often taken multiple times a day, the patient literally is reminded every moment of his life. Psychotherapy is often necessary to console patients.
Most importantly, a patient must take the drugs exactly as prescribed, and always consult their doctor or physician when they have questions or concerns about their HIV treatment regimen. Our think Quest Team did just that: we contacted an expert in the field, Mr. Christopher M. Dezii, Associate Director of Medical Affairs for Bristol Myers-Squibb, specializing in patient adherence to HIV treatments. Here is what he had to say:
“You would think that because HIV is such a deadly disease that people would be serious about taking their medications. In reality, they're just as likely to not take medication as anybody else.” Unfortunately, young people seem to have particular trouble taking their medications, largely do to peer pressure. This is caused by the widespread opinion that HIV is no longer a “death sentence” : It is considered a “chronic disease” . It is not good to have an attitude like this and think that HIV is “just like hepatitis, etc.” This leads to kids being careless.
Another problem in keeping patients to adhere to their treatment regimens is a lack of social support from family, friends, etc. is a reason not to take medication. It is important that you take every medication . “That's why when we talk to patients about HIV we also talk to a girlfriend, parent, etc. to make sure that they take their meds.”
Mr. Dezii also commented “The key task now is not identifying that poor adherence exists, it is to design solutions to make people adhere.” Moreover, as we know, there are always two sides to a problem; well there are also two sides to a solution too. To improve patient adherence, the drug companies, on one side of the problem, can simplify the regimens, lessen the side effects, and decrease the toxicities. On the opposite side of the problem: Doctors can individualize the care of the patient, and make sure that he or she is educated about HIV. As Mr. Dezii said, “you'd be amazed how many people don't know what they're taking.”
Sources
- ""Treatment Adherence." 22 Aug 2002. AIDS Treatment Data Network. 22 Feb 2004. <http://www.aegis.com/factshts/network/simple/adhe.html >.
- Jani, Asim. Jani, Asim. "Adherence to HIV Treatment Regimens: Recommendations for Best Practices." Jun 2002. 22 Feb 2004 <http://www.apha.org/ppp/hiv/ >
- Dezii, Christopher. Personal interview.