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Adherence to HIV Drug Regimens

May 5, 2015

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Adherence  to HIV Drug Regimens

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 that fight HIV, as well as ten combination pills that contain 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 longer and healthier lives.

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 times, 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 gets processed by your body and enters your blood stream. The HIV drugs need to stay in your blood at certain levels to fight HIV. If the level falls too low, there is not enough drug to do the job of fighting HIV.

When you take your pills on schedule, you keep the right level 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 medication. 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 HIV drugs.

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. If you were taking one non-nucleoside reverse transcriptase inhibitor (NNRTI) -- say Sustiva (efavirenz) -- and you developed resistance to Sustiva, you would likely develop resistance to another NNRTI, like Intelence (etravirine). 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 needed to get the most benefit from HIV treatment. That means missing very few doses.

Starting and Choosing HIV Drugs

There are a number of things to think about when deciding whether to start HIV drug treatment. Two of those things are your CD4 count and viral load.

It is also important to think about whether you feel able to commit to taking your drugs correctly. 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 give you accurate information to answer your questions and address your concerns.

Barriers to Adherence for Women

Many women find it difficult to be adherent to their HIV medication for the following reasons:

  • 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 HIV+ women than HIV+ men
  • Other life stressors, such as childcare or parenting issues
  • Current or past problems with side effects
  • Active substance use or problems with alcohol
  • 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 adhere to their HIV drugs. Globally, violence against women is very common. For more information, see our article on Violence Against Women 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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