Importance of adhering to HIV treatment
Strict adherence is key to reducing the risk of drug resistance1
Ongoing adherence to a prescribed regimen is essential for maintaining viral suppression. Maintaining viral suppression can help decrease HIV-associated complications; viral suppression is second only to CD4 cell count as a predictor of disease progression. Additionally, according to DHHS guidelines, as long as a patient achieves and maintains an undetectable viral load for at least 6 months, sexual transmission of HIV to the patient’s partner can be prevented.1
What might optimal adherence help achieve?1
- Lower rates of resistance
- Better health
- Viral suppression
- Transmission prevention
HIV treatment continuum and retention in HIV care1
The HIV treatment continuum of care includes linkage to care, initiation of ART, adherence to ART, retention in care, and virologic suppression. Retention in care can be measured as regularly attending medical appointments and remaining in medical care, but many people with HIV are not retained in care. Retention in care is a vital aspect of treatment adherence and may lead to better outcomes in patients.
Common barriers to adherence1
Several factors such as prescribed regimen, clinical condition, and patient-provider relationship can influence adherence to ART. A multitude of patient-related factors that may pose barriers to adherence include:
- Inconsistent access to medications
- Depression and other mental illnesses
- Neurocognitive impairment
- Low levels of social support
- Low health literacy
- Stressful life events
- Alcohol/substance use
- Homelessness, poverty
- Nondisclosure of HIV serostatus/denial
- Stigma
- Financial/insurance status
- Treatment fatigue
Speaking with your patients about improving adherence1,2
Addressing medication adherence issues early on may help equip your patients to take on the challenge of managing HIV. Here are some reminders and routines to help your patients stay on track:
DHHS guidelines' strategies for addressing adherence1
Patients with problems adhering to ART
People with HIV having ART adherence problems should be placed on regimens with high genetic barriers to resistance. Other factors such as side effects, out-of-pocket costs, convenience, and individual preferences should also be considered if patients are having issues adhering to their prescribed ART. Developing resistance to a drug not only makes it ineffective in treating HIV, but it may lead to cross-resistance to the entire class of HIV medication.
DHHS recommendations on adherence to the continuum of care include assessing (and reassessing) the patient’s engagement in care and adherence to ART and clinic appointments; approaching patients about adherence problems in a constructive, collaborative, nonjudgmental way; and tailoring the approach to each patient’s needs or barriers to care.1
Measuring retention in care should be done consistently and can be measured by patient visits1:
- Minimum of 2 visits at least 90 days apart over a period of 1 year
- At least 1 visit every 6 months over a period of 2 years
ART, antiretroviral therapy; CD4, cluster of differentiation 4; DHHS, US Department of Health and Human Services.
References:
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. US Department of Health and Human Services. Updated September 12, 2024. Accessed January 8, 2025. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
- HIV.gov. Tips on taking your HIV medicine as prescribed. Updated August 19, 2024. Accessed April 1, 2025. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/tips-on-taking-your-hiv-medication-every-day
- World Health Organization. Guidance for best practices for clinical trials. Updated September 2024. Accessed February 25, 2025. https://www.who.int/publications/i/item/9789240097711