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Nonadherence to HIV Regimen
Oct 5, 2013

I am a pharmacy student with a general question regarding non-adherence with HIV regimens. What is the guideline for re-assessment of therapy following a period of non-adherence? After how many missed doses/days should the patient be re-assessed for potential resistance regarding their therapy? If the patient should be re-assessed, should they stop taking their regimen during this time? Thank you for your time.

Response from Dr. Young

Hello and thanks for posting.

As you point out, adherence is a critically important aspect to care. I'd suggest broadening your view of adherence to not just pill taking, but adherence to medical appointments, refills, etc..

There is no specific guideline for assessment of treatment following interruptions, but clearly a single short interruption (1-4 days, arbitrarily) is not associated with any significant risk of viral breakthrough.

Rather, I look at this as a behavioral pattern- if there are frequent missed doses (and we use the 95 % threshold as a standard bearer), then I will decrease the monitoring frequency, and look for possible viremia.

I don't generally recommend that patients stop their therapies, unless further ongoing adherence is likely to be very poor (and risk generating drug resistance). Indeed, I typically use the opportunity to discuss strategies for enhanced adherence.

Remember that viremia in the setting of very poor adherence may not necessarily mean that resistance or need to change regimens are present, so that obtaining resistance tests are necessary to confirm emerging viral resistance and to guide treatment decisions.

I hope that's helpful, please feel free to write back. BY



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