Adherence To HIV Treatment

How can 'accepting' the fact that I have HIV help me with my medical treatment?

Hiding your head in the sand with HIV doesn't work because it just keeps going. It's very important, I think, psychologically, for the HIV positive patient to realise they have the disease, to accept they have the disease, and to not try denial because denial doesn't work. Accept what you can't change. You've got the infection and accept that you have to take your pills to control it and you'll be fine. Those that can't accept that they have HIV may stop their therapy, and they may do very badly as a consequence.

Why is 'adherence' important during my HIV treatment?

Adherence, or taking your pills correctly and on time, is critical for the treatment of HIV. It is the most important issue because this virus is only kept suppressed if the drugs are actually in the blood at all times. The only way to keep the drug in the blood at all times is to take it very regularly at an interval that keeps the level up before it drops down to zero, or even close. That is the biggest and most difficult issue for some HIV patients, to adhere to taking their medicines regularly. Those that can do it do extremely well, and that's about half to 2/3 of patients. Those that, for whatever reason, can't regiment their life to taking a pill once a day if necessary, or twice a day if necessary, depending on the regimen, tend to do poorly

What can I do to help me be more adherent to my HIV medication?

There are many clues and tricks that you can give patients to help them take their pills regularly and on time. One thing that doctors can do is try and give them as few pills as possible and we've been able to do that now. We've reduced the pill burden steadily and, in fact, many patients just take one pill a day, which has the three drugs already in it, one pill once a day to control their disease. Many others have to take three or four pills once a day or twice a day, but the pill burdens now are not great.The sort of clues you can give patients are to use a plastic pill box which has got visible chambers in it so that they can see whether they've taken their dose. Very often people can't remember whether they've taken their dose that day or not. If they keep it in a multichamber device they can see whether they have. Another thing is to always take the pills first thing on getting up in the morning because life is regimented first thing in the morning. You tend to go to the bathroom, clean your teeth, make a cup of coffee. If you fit taking pills into that little ritual then you're not likely to forget it as opposed to taking them at night when you might come home tired, you might even come home drunk, you might fall asleep in front of the television and forget to take your pills. So there are many things. There are also alarm devices. People can set their cellular phone or their watch to ring. I know one man who was having difficulty taking his pills who set off his house alarm twice a day to remind him.

Can I stop my treatment if my HIV medication makes me ill?

Stopping HIV medication is not a good idea unless you're doing it in concert with your physician. Some regimens, some three drug regimens are dangerous to stop without consultation because it might lead directly to resistance, because the different components, the three different drugs last in the blood for different lengths of time. If you stop them all at once, one of the drugs might be left by itself in the blood for a long time and the virus will rapidly become resistant to it so you'll risk losing the whole thing if you stop it suddenly. But if you tell your doctor, he will be able to tell you which one to stop first and try and prevent that from happening. Generally speaking, though, if a patient begins antiretroviral therapy, that is because the disease is advanced and if it is advanced they need to take the drugs for life. Because if they stop, their immune system will fall back to just where it was when they began and deteriorate further over time. But I often wonder why patients worry so much about taking drugs constantly when they have HIV disease. I am ordinary middle-aged American. I have to take pills everyday for high blood pressure and high blood fat. Most middle-aged Americans take pills everyday so it's not so extraordinary to be an HIV positive patient and have to take pills to remain well.

What are some major causes of non-adherence to HIV medication?

Crystal methamphetamine is an HIV doctor's greatest nightmare and the greatest ally of the HIV virus is in the world today for two reasons. People who use crystal methamphetamine seldom ever practice safe sex. So they greatly facilitate the transmission of HIV. People have more sex and they don't care that they don't use protection. But worse than that, people who are infected with HIV who use crystal methamphetamine, have lives that become very disrupted, so they can hardly ever take their pills regularly. So the virus wins, because it's able to replicate, because of the lack of HIV medications. Crystal methamphetamine is the greatest cause in eastern Los Angeles of non-adherence to any anti-retroviral HIV medicine. The other big cause of non-adherence, the biggest other cause, is depression and mental illness. People who are depressed don't care if they live or die. They don't care if they take their antiretroviral pills. High levels of anxiety are also bad. If people are very anxious their life is very disrupted and they don't remember to take their pills. So it's very important that we get HIV-positive patients on anti-retroviral therapy off drugs like crystal meth and cocaine and it's also very important that we monitor their mental state and keep them mentally healthy and treat any depression they might have so that they're in a healthy mental state and will look after themselves and take their pills.

How can HIV doctors assist people who use crystal meth?

People who are on crystal meth are difficult to help. We at AHF don't have a separate drug treatment unit, but there are many around town. We have social workers who work with the patients, refer them to the treatment centres. The doctors are encouraged to ask the patients every single visit, if they are using illegal substances such as crystal meth and to constantly talk about the dangers and to remind them to get off the crystal meth, if they can. It's a bit like smoking, it's hard to get off crystal meth. But if the doctor mentions it, every single visit and works with the patients and tells them how important it is to get off crystal meth, you can have success. If the doctor ignores it, then the crystal meth problem just goes on unabated.