Better HIV Treatment Taking

posted: 29/06/2010

Researchers at the London School of Pharmacy have started a £2 million programme to improve how people take HIV treatments. They found out earlier that within six months of starting HIV treatment, more than one third of people were not taking HIV treatments properly.

Taking HIV treatments properly is tough for some people. For HIV treatments to work properly, you need to take all your HIV medicines at the right time, and every day. Missing doses means HIV will become drug resistant and the treatment will stop working properly.
 

The pharmacists are keen not to blame people for not taking HIV treatments properly, and instead want to understand things from the point of view of the person taking them, and find ways to give better support to each person.
 

Lead researcher, Rob Horne said “Health practitioners have a duty to facilitate informed choice about ART and to support optimal adherence in the long term. This research programme will provide an evidence base to help clinicians do this,” Professor Horne added. Pharmacists already know that not taking treatments everyday seems to make sense to people who don’t have any symptoms, or who want to avoid side effects, or when people are worried that the drugs may cause harm, or make you dependant.
 

They also hope this 5 year study, funded by the National Institute for Health Research, will help pharmacists improve treatment taking by people with several other long-term conditions, including asthma, inflammatory bowel disease, bipolar disorder, chronic kidney disease, renal transplant and epilepsy.
 

Treatment taking information and help

If you want more information about taking HIV drugs properly NAM have a useful booklet called adherence and resistance that you can download free and iBase also have useful guides here
If you want to talk about this with one of our advisers, please call 0161 274 4499 or email an adviser

Source

HIV Information on Tour

posted: 17/05/2010

UPDATED 20 MAY - LEEDS and NEWCASTLE DATES CORRECTED

HIV and Your Body is the theme for free workshops for people living with HIV. Find out more about HIV and your Heart, Kidneys, Bones, Liver, and Body Shape.

Robert Fieldhouse, the editor of Baseline, is running a series of talks in the North-West, Midlands, West Yorkshire and North East of England.
 

Blackburn        with THRIVINE at Jarman Centre 53 James Street, Blackburn, Lancashire BB1 6BE
contact James 01254 263 525
Saturday 22 May 2pm HIV and your Bones
Tuesday 17 August 6pm Choice of HIV and Your …. Heart, Kidneys, Liver, and Body Shape

Manchester      at Black Health Agency (BHA) 464 Chester Road, Manchester M16 9HE
Monday 5 July                1pm       HIV and your Kidneys
Monday 6 September       1pm       Choice of HIV and Your …. Heart, Bones, Liver, and Body Shape
contact BHA 0845 450 4247

Birmingham         at ABPLus 29-30 Lower Essex Street, Birmingham, B5 6SN 

Tuesday 13 July             7pm       HIV and your Liver
Tuesday 10 August         7pm       Choice of HIV and Your …. Heart, Kidneys, Bones, and Body Shape

Leeds                      at Skyline 4th floor Gallery House, The Headrow, Leeds, LS1

CORRECTED DATES

Thursday 8 JULY              6pm       HIV and your Body Shape
Thursday 5 August          6pm       Choice of HIV and Your …. Heart, Kidneys, Bones, and Liver
 

Newcastle upon Tyne       at Body Positive North East 12 Upper Princess Square, Newcastle, NE1 0191 232 2855
Wednesday 7 JULY       3.30pm         HIV and your Heart

Wednesday 4 AUGUST        3.30pm         Choice of HIV and Your …. Heart, Kidneys, Bones, and Liver
The Leeds and Newcastle dates on the postcard with detilas of this talks tour are incorrect. Robert has told us the corrected dates above.

Further details from the speaker Robert Fieldhouse 07886 159 735 or by email

These talks are all funded by the drugs company Gilead Sciences
 

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
 

Alcohol Halves Adherence

posted: 14/08/2009

The more alcohol people drink, the worse their adherence to HIV treatment. HIV-positive people who drink alcohol are about half as likely (50%) to take HIV treatments properly, compared with people who don't drink.

A meta analysis, a study of all the past studies, of drinking and HIV treatment adherence, reveals this in a leading HIV journal.

And people who are heavier drinkers are even more likely to miss taking HIV drugs - 60% of heavier drinkers have poor adherence. It's the amount drunk in a session, rather than how often you drink, that seems to make adherence worse.

Taking HIV treatments properly is vital

For HIV drugs to work properly people need to take their HIV drugs at least 95% of the time - if some medications are not taken at the correct time interval, the drug level can either be too high (causing unnecessary side-effects) or too low (encouraging viral resistance).

Not taking treatments properly also makes it more likely HIV will be passed on and that this HIV will be drug resistant too.

If you want your treatment to work, daily, near-perfect adherence (above 95%) is needed.

This includes following any instructions about 

• taking the drug on an empty stomach OR
• with food
• taking ALL the drugs prescribed, and
• taking each drug at the correct dosing time.

This means a lot of accuracy, consistency, and commitment. Help is available - many people find 95% adherence hard to match, but there are tips and tricks and bits of kit to help.

What does 95% adherence mean?

• Take drugs once a day - miss up to one dose a month
• Take drugs twice a day - miss up to three doses a month
• Take drugs three times a day - miss up to four doses a month.

You should aim for better - ideally never missing any doses, with 100% adherence.

Alcohol and treatment

Drinking alcohol has been linked with reduced adherence to HIV treatment in many studies. However, it wasn't clear exactly what the links between drinking and treatment-taking were. Therefore the investigators put together all the published and scientifically reliable studies made between 1996 and 2007.

They analysed 40 studies. The studies had used different methods and adherence wasn't always the golden guide of at least 95% ('adherence' in the 40 studies ranged between 90% - 100% of doses).

However, when combined, the studies showed that people who drank alcohol were between 50% and 60% more likely to be considered non-adherent, compared with people who did not drink.

Heavier drinking, worse adherence

Furthermore, the amount someone drinks affects adherence. People who drink above the USA 'problem drinker' level are roughly 60% more likely to not take their treatments properly, compared with moderate drinkers or non-drinkers.

When they looked at the evidence more closely they found that what matters is how much you drink at a time, not how often you have a drink. The investigators write, “taken together, the available evidence suggests that drinking quantity is a more robust and important criteria of adherence than drinking frequency, a finding that seems consistent with dose-related alcohol effects on adherence.”

Male drinkers have worse adherence than women drinkers

One of the things they found was male drinkers are worse at taking treatments properly than women. In the past it had been thought women drinkers took treatments less well than men. Putting all 40 studies together mean that we now know this was wrong. Many men drinkers are worse at taking treatments properly.

Why is taking treatments worse among drinkers?

The study authors are less clear about the reasons why drinking affects taking treatments. They therefore suggest “future research should continue to evaluate potential moderators to clarify the conditions under which alcohol use is likely to influence adherence.”

Immune system doesn't work so well for drinkers 

Drinking alcohol has also been shown to affect how well the immune system works. In the light of this research and their own meta-analysis, the researchers conclude, “successful alcohol interventions could potentially show salutary effects on disease progression and, theoretically, life expectancy.”
 

Help with adherence

Adherence Tips factsheet from NAM

Adherence factsheet from NAM

Adherence booklet from NAM - page 25 includes useful tips, tricks and hints to help take HIV treatments properly. There are pill boxes, setting a daily alarm on your watch or mobile, keeping a little notebook and diary to jot down dates and times you've taken the treatment. And page 28 gives advice on clubbing and late nights out.  

Help with drinking

Alcohol factsheet from NAM

If you are concerned about your alcohol use, speak to an adviser at George House Trust, your GP, or the HIV clinic. 

Alcohol Concern's website is worth a look, or call Drinkline on 020 7264 0510.

Gay men may find the drink, drugs and smoking help from LGF useful.

The different parts of NW England each have their own NHS services for alcohol, provided by your local Primary Care Trust.

Reference Hendershot CS et al. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr (online edition), 2009.

Source edited and added to

Oldham - Have Your Say

posted: 04/11/2008

Oldham PCT wants your help in improving HIV prevention, treatment and care services for Oldham residents!

Please tell them what you think of their current services and let them have any suggestions by completing one of these two surveys.

Survey for people living with HIV

Survey for all - about HIV prevention

Live in Oldham and living with HIV?

If you live in Oldham and are HIV positive then there is a consultation event that will be in Oldham on the 3rd of December 5.30pm - 7.30pm.

Please contact Lynda Shentall Director of Services for more information or ring us on 0161 274 4499