Antiviral Benefits for Hiv-Infected Patients: The Crucial Role & Multiple Determinants of Adherence (Commentary) (Human Immunodeficiency Virus)
The life saving benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV infection have been well documented (1). HAART needs very high levels of adherence to be effective and to prevent appearance of viral mutations related with resistance (2,3). Despite a lack of corroborative evidence, specific concerns have been raised regarding the ability of patients in the developing world to adhere to HAART regimens. Thus it has been shown in a meta-analysis published in 2005 that in several African countries HAART resulted in an HIV RNA suppression in similar proportions of patients to that observed in developed countries (4). Patient’s adherence to the prescribed treatment is driven by multiple causes, some of them related to the treatment itself, others related to social and psychological barriers. The number of pills to be taken at each administration, the number of administrations per day, dietary restrictions, short-term treatment tolerance, and the presence of depressive symptoms, have been shown to be related to adherence (5,6). In African settings, adherence has been shown to be better in patients who received therapy free of charge than in patients who had to pay for therapy (4). Nevertheless, in 34 patients from Uganda purchasing generic HAART, multiple adherence measures showed that they took 91-94 per cent of their prescribed therapy (7).