Adherence with ART

How will I know if my patients are adherent with their antiretroviral regimens?

Antiretroviral medications slow or halt replication of HIV in the body. By doing so, the immune system has the opportunity to rebuild itself and the patient has decreased risk of opportunistic infections, better weight gain, and improved quality of life. There are both clinical and laboratory goals of antiretroviral therapy. Routine assessment of the patient’s physical condition, interval history, and laboratory tests are useful ways to evaluate adherence. Patients who do clinically deteriorate, and/or who maintain decreased viral load and stable or increasing CD4+ lymphocyte counts are typically adherent with their antiretroviral regimens. If a patient develops frequent opportunistic infections, increasing viral load, or decreasing CD4+ lymphocyte count, nonadherence may be an issue.

In our experience, nonadherence is a more common explanation for treatment failure than is drug resistance, per se. Nurses need to assess adherence at every clinic visit by asking the patient if they have had any difficulty taking their antiretroviral drugs, and if they have missed any doses. If the patient is instructed to bring the medication bottles each time, a pill count can be done to determine missed doses.