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    Imperfect HIV Drug Use Raises Resistance Risk

    Failure to Take Medications as Directed Could Quadruple Drug Resistance Risk

    Helping HIV Patients Take Their Medications

    In the U.S., researchers say nearly 50% of HIV patients have detectible levels of the virus in their blood, an indicator that they may not be taking their HAART medications as prescribed.

    Experts say failure to take HAART as prescribed is a major factor behind treatment failure and progression to AIDS. Although nonadherence is a common problem in many diseases, researchers say the issue is particularly dangerous in HIV treatment.

    "Nonadherence is nonforgiving with HIV infection," says John G. Bartlett, MD, chief of the division of infectious disease at the Johns Hopkins University School of Medicine in Baltimore, Md. "If you don't take your blood pressure medication, your blood pressure goes up for that day and then goes back down again. But with HIV medication, you don't get the chance of them being active or effective later."

    The antiretroviral drugs used in HAART work by preventing the virus from replicating. But when a dose of the drugs is missed, the levels of the virus in the blood can rise rapidly and begin to mutate, which increases the likelihood of resistance.

    One of the reasons it has consistently been difficult for HIV patients to take their medications as prescribed is that the treatment regimen often required taking as many as 14 pills at different times or with different food restrictions.

    But researchers say the number of pills required for HAART is now as low as two or three pills once a day and is predicted to drop to one pill per day within the next year.

    In the meantime, a team effort is required to help HIV patients stick to their drug schedule, according to Kathleen Squires, MD, associate professor of medicine at the University of Southern California, who also attended the briefing.

    That team approach often includes:

    • Assigning a case manager who sits down with the patient and helps them visualize how they will fit taking HAART into their lifestyle.
    • Offering directly observed therapy in which a health care worker goes to the patient's home to deliver treatment, or the patient comes to the clinic to get medication.
    • Group or individual counseling at a variety of locations, including clinics, community organizations, or the patient's home.

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