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Adherence to HIV Drug Regimens

August 14, 2018

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Table of Contents

Strong Drugs to Fight HIV

The many advances in HIV treatment in the past 25 years have led to the approval of over 30 drugs to fight HIV, including several once-a-day combination pills containing two or more HIV drugs. This is a remarkable accomplishment. Most importantly, using these drugs in effective combinations is helping many people control their HIV and live long, healthy lives. Unlike in years past, HIV is no longer a death sentence; instead, it now can be much more like living with a chronic, but manageable, condition that has little effect on life expectancy.

In order for HIV drugs to do their job properly, you need to do yours! It is very important that you take your drugs exactly as they are prescribed. That means taking the correct amount (dose) at the right time(s), and as directed (e.g., with any food or medication restrictions). This is called adherence.

Despite the improvements in HIV drug treatment (such as fewer side effects, fewer restrictions, and easier dosing), taking HIV drugs is still a daily, lifelong commitment. While this can make adherence challenging for many people living with HIV (HIV+), the benefits are well worth the effort.


The Importance of Adherence

When you take a drug, it is processed by your body and enters your blood stream. A certain amount of the HIV drug needs to stay in your blood to fight HIV. If the drug level falls too low, there is not enough drug to fight HIV.

When you take your pills on schedule, you keep the right amount of the drug in your body. If you do not take your HIV drugs on schedule, drug levels in your blood will drop and HIV will be able to make copies of itself (multiply or reproduce). When HIV multiplies, your viral load increases and your CD4 cell count goes down.

When HIV makes copies of itself, it sometimes makes changes, called mutations. These mutations can help the virus survive, even when you are taking your HIV treatment. This is called resistance. When HIV becomes resistant to a drug you are taking, that drug will stop working. At that point, you will probably have to switch to a different HIV drug.

Resistance to one drug can sometimes cause resistance to other drugs you have not taken. This is called cross-resistance. Resistance often develops to other drugs in the same class (type of drug). If you develop resistance to one drug in a class of drugs, it is likely that you will have developed resistance to other drugs in the same class. As a result, resistance can affect your treatment choices in the future because fewer drugs will work well against your virus.

The best way to prevent resistance is to stick closely to your medication schedule. Some studies suggest that taking your HIV drugs exactly as prescribed about 95 percent of the time is necessary to get the most benefit from HIV treatment. That means missing very few doses.

Starting and Choosing HIV Drugs

Experts now agree that starting treatment as soon as you are diagnosed, regardless of your CD4 count or current state of health, gives you the best chance of staying healthiest the longest. Nevertheless, starting treatment is a big decision.

Before you get started, it is important to be prepared and commit to taking your HIV drugs the right way, every day, for your own health. If you do not feel ready, talk it over with someone who knows about HIV. Your health care provider or an AIDS service organization (ASO) can answer your questions and address your concerns. Click here to find an ASO in the US. To find services across the world, visit AIDSmap's e-atlas.

Your provider will help you choose the HIV drugs to start with. This choice includes several important factors: which drugs will be most effective in fighting your HIV, side effects, dosing schedule, and possible drug interactions.

For more information, see our fact sheets on Considerations Before Starting Treatment and Starting HIV Treatment.

Barriers to Adherence for Women

Women living with HIV can face numerous challenges to taking their medicine as prescribed. Women often put others' needs before their own. Other barriers to adherence include:

  • A busy lifestyle
  • Not having disclosed their HIV status to work colleagues, friends, lovers, or family
  • Depression, a leading cause of non-adherence, is more common in women living with HIV than in men living with HIV
  • Other life stressors, such as childcare or parenting issues
  • Current or past problems with side effects
  • Active substance use or problems with alcohol use
  • In the US, women who do not have health insurance are less likely to be able to access adequate care and HIV drugs
  • Many women living with HIV do not have safe or stable housing; this presents additional barriers to getting treatment
  • Past or current experience of violence or trauma. Women who have been abused are four times more likely not to take their HIV drugs as prescribed. Globally, violence against women is very common. For more information, see our fact sheets on Violence Against Women and HIVViolence Against Women and HIV and Trauma and HIV.
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.


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