Time Makes Treatment-Taking Easier
posted: 01/04/2010
Taking HIV treatments gets easier the longer you take HIV antiretroviral therapy, London investigators report. Of over 2000 patients in London who have been treated for up to nine years most took their HIV treatments properly and got 2% better each year at taking the HIV treatments.
“These encouraging observations have implications for our understanding of the likelihood that patients will be able to maintain sufficient levels of adherence for a lifetime”, comment the investigators from London’s Royal Free Hospital.
95% Adherence Target
Very high levels of adherence (at least 95%) are needed to achieve and maintain an undetectable HIV viral load. 95% means you can only miss one dose a month if you take one dose a day, or you can miss up to 3 doses if you take treatment twice a day. If you miss more doses of HIV drugs than this the viral load rises, HIV can become resistant to the drugs, CD4 count falls and there is a bigger risk of illness and even death.
Treatment Taking Doesn’t Drop
Some earlier studies seemed to show that the longer you take HIV treatment, the worse you become at taking it. But those were small studies for short periods. Investigators at the Royal Free Hospital in London decided to do a bigger study, for longer. The Treatment taking – adherence – of 2060 patients was monitored every six-months. Adherence is measured here by the proportion of days in the six months where the person was protected by antiretroviral drugs. The study covered people for around 4.5 years – some people for up to nine years. Most were male (78%), white (66%), and maintained an undetectable viral load for the whole time (79%).
92% were protected by their treatment
Median coverage of HIV treatment during the study was 92%. This remained stable throughout the study.
Getting better all the time
Far from declining, there was a trend suggesting that adherence increased the longer a patient received treatment, by around 2% a year.
Taking treatment problems and successes
Some people do find taking HIV treatments much more problematic – for example black heterosexual men. They suggest, “this is likely to relate to socioeconomic and migration status, characterised by more difficult access to care, and perhaps less access to information”. George House Trust would suggest that it is probably much more to do with HIV stigma and perhaps being in some ‘denial’ about having HIV, although poverty and migration problems don't help.
People who have had three or more virologic treatment failures were much less likely to be taking treatments properly than people who kept their viral load undetectable.
As you get older your treatment taking gets much better. They suggest older people are more likely to attend their clinic appointments and “are more aware of the negative clinical effects of low adherence.”
Some treatments easier to take
Combinations with boosted atazanavir (Reyataz) or boosted saquinavir (Invirase) were taken better. This is probably because of fewer side effects with the newer HIV drugs – treatment taking was usually poorer in the earlier years.
Treatment drop out follows adherence problems
There is evidence that poor adherence levels predicts people who may drop out from clinics. People with poor adherence (below 60% drug coverage) were significantly more likely to be lost to follow-up than those with the best levels of adherence.
Getting better
The researchers found that almost half the people struggled with adherence at least once – but then got over the problem.
“We found no evidence of a decrease in average levels of adherence to HAART [highly active antiretroviral therapy] over time, and even some evidence of a small increase”, comment the investigators.
The levels of adherence observed in the study fit with the high proportion of patients with an undetectable viral load in the cohort.
Could people get by with under 95% adherence?
Some researchers have suggested that with newer HIV drugs, people might get away with taking treatments less than 95% of the time. But the investigators suggest that the highest possible level of adherence should always be the target. This not only means that there is a very low risk of treatment failure and resistance, but also suppresses HIV levels in genital secretions, thereby reducing the risk of sexual HIV transmission.
“Adherence to antiretroviral therapy is generally high in routine practice and does not have a tendency to decline over…long periods, providing encouragement that maintenance of adherence for a lifetime may well be possible’, conclude the investigators.
Need help with HIV treatment adherence? These may help, or call your HIV clinic, or call our services team
Adherence and resistance booklet (NAM)
Online adherence course - USA site
Treatment passport to help you keep track of taking treatments, side effects, CD4, VL
Source with reference
Permalink