HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts

Abstract

Poor adherence to combined antiretroviral therapy (cART) has been shown to be a major determinant of virologic failure, emergence of drug resistant virus, disease progression, hospitalizations, mortality, and health care costs. While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of cART, long-term adherence remains a challenge regardless of available resources. Barriers to optimal adherence may originate from individual (biological, socio-cultural, behavioral), pharmacological, and societal factors. Although patients and providers should continuously strive for maximum adherence to cART, there is accumulating evidence that each class of antiretroviral therapy has specific adherence-drug resistance relationship characteristics allowing certain regimens more flexibility than others. There is not a universally accepted measure for cART adherence, since each method has distinct advantages and disadvantages including cost, complexity, accuracy, precision, intrusiveness and bias. Development of a real-time cART adherence monitoring tool will enable the development of novel, pre-emptive adherence-improving strategies. The application of these strategies may ultimately prove to be the most cost-effective method to reduce morbidity and mortality for the individual and decrease the likelihood of HIV transmission and emergence of resistance in the community.

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…2 Many studies have demonstrated that youth living with HIV frequently have poor medication adherence. 3 Several crosssectional studies have described low self-efficacy, depression, poor coping styles, and poor social support as social-cognitive predictors of low adherence.…”

HIV vs. the Immune System: A Differential Game

“…Once explained the common features of the CD4+ T-Helper cells, let's explicate the terms which characterise the dynamics of the naive T lymphocytes (T h ) in Equation (3).…”

“…The adverse effects and the complexity of treatment regimens (due to the high number of pills and to dosing frequency) may reduce patient's compliance [3].…”

Social Determinants of HIV Health Care: A Tale of Two Cities

“…Pill counts (Achieng et al 2011) and pharmacy refill monitoring have been shown to be reliable and inexpensive but not consistent across all settings. Directly observed ART has also been examined with mixed results but overall is costly and labor intensive (Nachega et al 2010;Hart et al 2010), as is therapeutic drug monitoring via plasma or hair sampling (van Zyl et al 2011). …”