Adherence to HIV Drug Regimens

Table of Contents

• Strong Drugs to Fight HIV
• The Importance of Adherence
• Starting and Choosing HIV Drugs
• Barriers to Adherence for Women
• Overcoming Barriers
• Adherence Tips
• Finding Support

Strong Drugs to Fight HIV

The many advances in HIV treatment in the past 20 years have led to the approval of 25 drugs that fight HIV, as well as five 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! Your job is to 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 reduced side effects, fewer restrictions, and easier dosing), taking HIV drugs is still 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, the drugs do not work well.

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). 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 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 the staff at 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 are less likely to have health insurance than men. Without health insurance, women are unlikely to be able to access adequate care and HIV drugs
• Many HIV+ women do not have safe or stable housing; this presents additional barriers to getting treatment