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Strategies to increase adherence to therapy among HIV/AIDS patients should target different HIV risk groups

Patients who have HIV/AIDS must adhere to antiretroviral medication therapy in order to suppress the virus and maintain clinical well-being. However, the benefit of these often complex drug regimens can quickly be offset by even short-term nonadherence. Certain groups of patients are less likely than others to adhere to therapy, and the factors underlying their nonadherence are HIV risk-factor specific, according to a study supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-98-0016).

Researchers at the Johns Hopkins University School of Medicine examined responses to a survey on antiretroviral adherence (percentage of prescribed doses taken over a 2-week interval) completed by 196 HIV-infected patients who were taking at least one antiretroviral medication. The survey was administered while the patients were waiting to see their primary care provider. Overall, 2-week adherence in the sample was 80 percent, while 71 percent of the sample reported adherence of 90 percent or greater with all prescribed antiretroviral medications.

In patients with a history of injection drug use, nonadherence was independently associated with eating fewer than two meals per day and active illicit drug use. In patients without any injection drug use, nonadherence was associated with social pressures outside of the clinic such as lack of food or money. Males who had sex with males were much more likely to adhere to their antiretroviral regimen than were patients with an HIV risk factor of high-risk heterosexual activity. Interventions that address social stresses, such as running out of money and food, and interventions that treat substance abuse are most likely to increase adherence in these patients, suggest the researchers.

More details are in "Association of social stress, illicit drug use, and health beliefs with nonadherence to antiretroviral therapy," by Kelly A. Gebo, M.D., M.P.H., Jeanne Keruly, M.S., C.R.N.P., and Richard D. Moore, M.D.,. M.H.S., in the February 2003 Journal of General Internal Medicine 18, pp. 104-111.

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