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Adherence Is Reduced in Patients Who Don't Think They Need Antiretroviral Treatment

Adherence is a key contributor to optimal response to antiretroviral therapy. Many factors influence good or poor adherence, including an individual's perceived need for treatment, according to a study published in the December 1, 2008 Journal of Acquired Immune Deficiency Syndromes.

Dutch researchers studying the ATHENA cohort looked at participants' attitudes about anti-HIV therapy, including perceived efficacy, likelihood of side effects, and whether they thought they needed treatment.

This cross-sectional analysis included 341 patients receiving HIV care at 21 clinics in the Netherlands between 2000 and 2004. Study participants completed questionnaires covering demographic characteristics, antiretroviral treatment history, side effects, adherence, and perceived need for treatment. Most (90%) were on HAART and about 75% had undetectable HIV viral load.

Results

• 95% of patients agreed that their antiretroviral drugs kept their HIV under control.
• 88% agreed that their current health depended on taking anti-HIV therapy.
• 87% agreed that their future health depended on taking therapy.
• 72% said they sometimes worried about long-term drug-related side effects.
• 52% said they thought they were likely to experience adverse side effects within the next month.
• 25% reported episodes of non-adherence within the previous month.
• 30% of participants who reported poor adherence had detectable HIV RNA, compared with 18% of those who reported 100% adherence (odds ratio [OR] 2.0).
• Patients with a higher CD4 count were more likely to say they did not think they needed antiretroviral therapy.
• Patients who did not think they needed treatment had significantly higher rates of non-adherence (OR 1.6) and detectable viral load (OR 1.9).
• Patients concerned about side effects, however, were not more likely to report non-adherence or to have a detectable viral load.

Based on these findings, the study authors concluded, "patients with lower beliefs about the necessity of [antiretroviral treatment] were more likely to be non-adherent and to have a detectable viral load."

They recommended further studies to determine whether educating patients about their personal need for treatment might lead to increased adherence.

Department of Medical Psychology Academic Medical Centre Amsterdam, Netherlands; Erasmus Medical Centre Rotterdam, Netherlands; University Hospital Maastricht Maastricht, Netherlands; HIV Monitoring Foundation Amsterdam, Netherlands.

1/23/09

Reference

IM de Boer-van der Kolk, MA Sprangers, MV Ende, and others. Lower Perceived Necessity of HAART Predicts Lower Treatment Adherence and Worse Virological Response in the ATHENA Cohort. Journal of Acquired Immune Deficiency Syndromes 49(4): 460-462. December 1, 2008.