Practical advice and individualized attention can help people with HIV stick to a consistent drug regimen, according to a new review of studies.
The studies were too different to combine results, but the review team found that the most successful programs emphasized “practical medicine management,” one-on-one attention or a 12-week or longer duration.
Today’s powerful antiretroviral drug combinations work best when patients follow doctor’s orders, but many patients struggle to adhere to a strict medication schedule.
The review examined 19 studies that tested different patient education and support strategies.
“A one time visit probably is not going to do it. You need multiple visits over a period of time with someone who can talk to you about your individual needs,” said, study author Richard Glazier, a family doctor at St. Michael’s Hospital in Toronto.
He said practical medicine management was associated with better outcomes than strategies that took a psychological tack by providing cognitive behavior therapy or motivational interviews.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
Drug adherence is a problem in all of health care, Glazier said. . “It has to do with not remembering every day. The phenomenon is the same among people with diabetes, high blood pressure, cholesterol or HIV. People don’t take all their doses because they are distracted, because they’ve run out of their medication, because they’ve been traveling,” he said.
Poor drug compliance is not unique to HIV care. But the issue is complicated because HIV drug regimens can be complex and because inattentive dosing can curb a medicine’s ability to suppress virus in the body.
A typical HIV drug cocktail includes at least three different medications and can include many pills taken at precise times throughout the day.
“These drugs are real lifesavers, but if you stop your medications and start them again, - and kind of do that repeatedly - the virus is very smart, and it can develop resistance,” Glazier said.
Even brief periods of non-adherence can have lifelong implications. Once the body builds up resistance to a particular drug cocktail, it is no longer effective and doctors have to find another medication combination among the short list of available antiretroviral drugs.
While the consequences of non-adherence are severe in HIV care, Glazier said: “it’s not a hopeless case. These interventions by and large have the potential to work, adherence is a huge problem, but a variety of different kinds of interventions have been shown to be helpful.”
Practical medicine management educates people with HIV about why and how to take their medication and helps them overcome everyday barriers like forgetfulness and privacy concerns.
Drug management help often includes memory aids like beepers, alarms or clear plastic medication boxes labeled with the day of the week.
Charles Davis, an infectious disease specialist at the Institute of Human Virology in Baltimore, said pharmaceutical companies have done a good job creating powerful drugs to suppress the AIDS virus, extend life and dramatically improve health. But he said providers at his HIV clinic discovered that many patients were tripped up by the practical, social and psychological impediments surrounding HIV treatment.
“These medicines work when they are taken the way they are supposed to be taken,” Davis said. “They don’t cure, but they work. We see people living longer lives and a better quality of life.”
Rueda, S. et al. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS (Review) The Cochrane Database of Systematic Reviews 2006, Issue 3.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
Health Behavior News Service
Revision date: June 21, 2011
Last revised: by Andrew G. Epstein, M.D.