The Importance of Adherance

What is Adherence?

Adherence is a technical term for taking your treatments routinely, in the way that your doctor has prescribed them.

The information on how to correctly take your treatments is written on the container your treatments come in, and upon the Consumer Medicine Information (CMI) leaflet that is also provided in the packaging that comes with your treatment.

Drug Resistance & Adherence

Whether you are on a twice-daily or once-daily HIV treatment regimen, you need to take your pills daily (around the same time every day) whilst aiming for at least 95% (or better) consistent (every-day) adherence, without skipping or missing doses. Some HIV treatments are more ‘forgiving’ in terms of missed doses, but aiming for at least 95% consistent adherence is the best way to guard against resistance occurring for all HIV treatments.

HIV drug resistance is caused by changes in the genetic structure of HIV that affect the ability of medicines to block the replication of the virus. All antiretroviral drugs, including those from newer drug classes, are at risk of becoming partially or fully inactive due to the emergence of drug-resistant virus. When drug resistance occurs it may prevent your HIV treatments from working as well as they should, depending upon the level of resistance that develops.

Being 100% adherent is always the best safeguard against drug resistance, and may also improve the benefits against HIV.

A good way to measure whether you have achieved 95% consistent adherence in taking your pills is to do a pill count as follows:

If at the end of a 30 day supply of ONCE DAILY treatment, you have no more than ONE (1) DOSE left to take, then you have been 95% adherent. Congratulations!
If at the end of a 30 day supply of a TWICE DAILY treatment, you have no more than THREE (3) DOSES left to take, then you have been 95% adherent. Congratulations!

If you have MORE than these amounts left in the pack or bottle, then your adherence to treatment is less than 95%, and drug resistance or drug failure can occur.

If you’re having troubles staying adherent to treatment, seek some support and tips on how to remember to take them, or how to overcome the barriers that might be causing you not to take them. There might be many reasons that adherence is a problem for you, and many of them are solvable with a bit of help.

Different people find different things to help establish the daily routine. If there are things getting in the way of you taking your treatments or side-effects are bothering you, tell your doctor what your concerns are.

Drug Interactions

Drug interactions can also be a cause of drug resistance. This is when the HIV drug levels are affected (causing a decrease in the amount or concentration of drug in your body) by another drug you are taking – this can include over the counter, non-prescription drugs (that you have purchased yourself) as well as prescribed drugs.

Generally, your doctor will NOT prescribe a treatment that may interact with your HIV treatments, but this can sometimes occur if you have more than one doctor where each doctor does not know about treatments you may be on as prescribed by another doctor.

That is why it is important to tell any doctor if you are on HIV medications as it will influence the type of other drugs that can be prescribed to you. Some HIV drugs interact more than other HIV drugs with other medicines. Your HIV pharmacist also needs to know what other drugs you are taking other than HIV treatments, for this same reason.

You should tell your doctor and pharmacist about every treatment you are currently taking or may take – this also includes any medicines, herbs, or supplements you buy without a script off the chemist, store, supermarket, or health-food store shelves.

It is also important to know that drug interactions can also be the reason that treatment side-effects occur. This is because the incorrect level of medication in your body can be associated with the emergence of different side effects.

For further information on HIV drug interactions, including an interactive database as well as a useful App for your iPhone or iPad or other mobile device, please visit HIV Drug Interactions’ website.

Transmission of Drug-Resistant HIV

A lack of adherence to antiretroviral therapies (cART) has been shown to be a major determinant of the emergence of drug resistant HIV (which generates drug resistance within the person living with HIV).

Whilst transmission of drug resistant viruses occurs, it is usually only “partial resistance”, which does not automatically mean that all of the available HIV drugs won’t work. Essentially, most drug resistance may only mean that some drugs do not work as well, but some still are still effective for treating HIV. In these situations, people with HIV may require more complex treatment regimens (i.e. the number of HIV drugs required may increase beyond the standard 3 drug regimen).

However, there have been next to no cases where none of the HIV drugs will work. Rarely has anyone run out of HIV treatment options these days (which is good news!).

The gradual increase in the transmission of drug resistant HIV is a major reason for HIV doctors now testing for drug resistance before someone first starts HIV treatment. This is to make sure that the HIV treatments that are being considered will be effective in suppressing HIV to undetectable levels – this is the goal of HIV treatment. This test for resistance is called the Genotypic Resistance Assay (GRA).

Recent news on drug resistance can be found on the POZ website.

Side Effects & Changing Treatment

Modern HIV drugs tend to have minimal side-effects but some side effects can still occur. This is why all changes to your treatment should always be in consultation with your HIV doctor.

Where Can I Get Treatment?

People living with HIV can get their HIV medication from their local pharmacy, an online pharmacy or a hospital-based pharmacy, whatever suits them better.

How Much Does Treatment Cost?

Treatment for HIV is available throughout Australia at highly subsidised costs for Medicare Card holders, through the PBS.

When Should I Start Treatment?

It is important to discuss all the benefits and risks to starting treatment, and your personal readiness to start treatment with your doctor. Today, most people are recommended to start treatment once a diagnosis is confirmed.

Participating In Trials

Generally the benefit of research is that it assists the majority of people and helps to discover new science and evidence for health and treatment for the benefit of the entire population, possibly even yourself. The decision to be in a trial is always your own.

Our trained team is here to help you should you have any questions or need support. You can call for free from a Queensland land-line on 1800 636 241 or call (07) 3013 5555 (national). You can also email us or use the contact form or the chat function in the corner of our website.