Taking Medicine for HIV Proves Hard to Swallow for Many People

Highly active antiretroviral therapy has increased the longevity and quality of life for people living with human immunodeficiency virus. But it requires strict adherence in taking the medicine, something that is extremely difficult for many individuals to do.

Two new University of Washington studies illustrate just how hard it is to make sure people take their HIV medication. One study looked at the effects of drinking alcohol on adherence and showed the risk for non-adherence was double among drinkers compared to abstainers. The second study evaluated interventions using peers, electronic pagers or both, and showed that these tools promoted no lasting improvements in adherence rates.

“HIV is unique in the adherence levels needed to be effective,” said Jane Simoni, a University of Washington psychology professor who specializes in studying adherence. She is the lead author of the pager-peer paper and a co-author of the alcohol study.

“Typical adherence for people taking medication is 50 percent. But 50 or 60 percent adherence isn’t going to work for HIV medications and will lead to resistance to the drugs. Taking drugs for HIV is a lifetime commitment; you are married to the pills,” she said.

The alcohol paper analyzed data from 40 previous studies involving more than 25,000 people and established that drinking does have a consistent effect on adherence across studies.

“Drinking quantity, more than frequency of drinking, is associated with non-adherence,” said Christian Hendershot, lead author of the alcohol study.

Hendershot is now a postdoctoral researcher at the University of New Mexico after earning his doctorate at the UW. Because the various studies had different criteria for drinking, the researchers used meta-analysis to examine three categories – any drinking, moderate drinking and problem drinking. The latter was defined as meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking – 14 drinks a week or more than 4 in a day for men – or meeting criteria for an alcohol use disorder.

“In general, people who drank alcohol had nearly twice the risk of non-adherence. But the risk of non-adherence went up as the level of drinking went up,” he said. “At problem levels of drinking we see a higher probability of non-adherence.”

However, Hendershot cautioned that these finding don’t necessarily hold for all people on HIV medication and who drink.

“Alcohol may have a causal effect, but there also may be other factors affecting both alcohol and adherence that partly explain the association. We need to treat people individually.”

For the peer-pager study, researchers recruited 224 patients being treated at a Seattle clinic. Patients were randomly assigned to one of four treatment groups – pager, peer, combined peer-pager and treatment as usual – for three months.