Study Indicates Majority of HIV-Positive Individuals Do Not Strictly Follow Antiretroviral Regimens
Fewer than half of HIV-positive individuals participating in a recent study took their antiretroviral medicines "according to directions," potentially opening the door for treatment failure and the development of drug-resistant HIV strains, Reuters reports. A study conducted by researchers from the Academic Medical Center in Amsterdam and published in the Sept. 10 issue of the Archives of Internal Medicine found that only 47% of the 224 participants said that they took all of their medicines "all the time as directed" (Reuters, 9/9). Nearly 90% of participants said they took all their antiretroviral medication, while 59.8% said they took all their medication "on time" and 47% took all their medication on time according to dietary requirements. Among the reasons that participants deviated from the regimen: 35% said they forgot to take their medicine, 24% said that it was "impossible to combine taking medication with activities of that particular moment," 22% said they felt "sick or ill," 19% cited a "change in daily routine" and 15% said their medicines were not available at the requested time (Nieuwkerk et al., Archives of Internal Medicine, 9/10). The researchers concluded that failure to adhere to antiretroviral regimens could pose a "significant" public health problem because it increases the chance that individuals will develop and transmit drug-resistant strains of HIV. They added that the "consequences" posed by failure to adhere to drug regimens will vary by medication. "To date, it is not known what level of adherence to (the drugs) is precisely needed to prevent viral rebound and the emergence of drug-resistant variants," they wrote. The researchers urged doctors to "consider a patient's ability to follow" certain regimens before prescribing antiretroviral therapy.
AIDS Group Notes Study Flaws
Representatives from the George House Trust, an HIV/AIDS charity in the United Kingdom, said that the study was conducted in 1998 and 1999, when some of the antiretroviral drugs "were very new" and drug regimens "were more complex than they are now." Denise McDowell, director of the organization, said, "We have got to recognize that it is very hard to change your lifestyle to fit the very complex regimes that many anti-AIDS drugs require. It is vital that doctors do not just dispense medication without spending time with people to work out which therapies and life changes are possible, on an individual basis" (BBC News, 9/10).