Why Adherence Matters for Ant... Video Transcript

Participants

, Brian A. Boyle MD, Ian Frank MD

Summary

As with other HIV medications, antiretrovirals are designed to be taken on a particular schedule, whether it's once, twice, or three times per day. Side effects can make these regimens hard to stick to -- and many patients don't. Unfortunately, the consequences of slipping from your schedule can be severe. Join our panel to learn why adherence matters, and what you can do to stay on track.

Webcast Transcript

MARIA GINGRICH: Welcome to our webcast. I'm Maria Gingrich. Many HIV drug therapies have carefully timed dosing schedules and multiple medications, making treatment a challenge. These complicated regimens can lead to missed doses and may ultimately result in drug resistance.

Here to talk about the importance of adherence and to outline ways to improve it is Dr. Ian Frank, Associate Professor in the Infectious Disease Division at the University of Pennsylvania. Thank you, Dr. Frank, for coming.

Let's start with a basic question. Doctor, what is adherence?

IAN FRANK, MD: Adherence means how accurately patients take their medications. It means following the prescriptions to the letter.

MARIA GINGRICH: So if someone were to skip a dose, would that affect them negatively?

IAN FRANK, MD: It may. We don't know exactly how adherent patients need to be in order to have the best results. We do know that the more adherent the patient, the more likely the patient is going to have best results.

MARIA GINGRICH: Also joining us today is Dr. Brian Boyle. He is Assistant Professor of Medicine at the Weill Cornell Medical College in New York. Thank you, Dr. Boyle.

Doctor, how important is medication regimen adherence to the treatment of HIV?

BRIAN BOYLE, MD: Well, medication adherence is as, I frequently say, the key to succeeding with HAART and succeeding with antiretroviral therapy. So I absolutely agree with Dr. Frank that adherence is extremely important, and I don't think that can be emphasized too much in patients taking their antiretroviral therapy. So if you start a regimen and if you take it religiously, your chances of success are extremely high. If you don't, your chances of failure are high, and failure means that you're not only not going to succeed with this regimen, but it may result in resistance to this and other regimens so that the virus is now resistant and can't be treated with this, or perhaps some other regimens due to cross-resistance, and it may mean eventually, if you fail enough regimens or the resistance you've developed is bad enough, that there is no treatment available for you with the current antiretrovirals that are available.

MARIA GINGRICH: Dr. Frank, another thing people with HIV might want to know are some of the factors that affect adherence in HIV-positive patients. Can you tell us what they are?

IAN FRANK, MD: Sometimes it could just be difficult to take the combinations because of the complexity that's involved. Sometimes medications need to be taken three times a day, sometimes with food, sometimes on an empty stomach, and just because of people's lifestyles -- the need to work, the need to be out and about -- it can be difficult for patients to remember to take medications with them, or they may not want to take medications in the middle of the day because they're with friends or they're with coworkers. They want to preserve their anonymity. So many patients prefer to just take medications at home.

There are also side effects that the medications cause, and if medications cause side effects and patients feel well without taking medications, then there's less incentive for people to want to take their medications. And there are other reasons, too, for bad adherence. Many patients feel depressed at times. They can be despondent. They may feel that the medications aren't really helping them in the way they'd like to be helped. Many patients, unfortunately, have problems with alcohol use, drug use, and these can get in the way of good adherence, too.

MARIA GINGRICH: So as much as these people want to get better, I can see that it's harder for them to stay with a regimen.