Adherence to HIV medications is the greatest predictor of death. How well patients with HIV adhere to their regimens of highly active antiretroviral therapy (HAART) medication depends on a variety of factors, either positive or negative, many of which are common to patients around the world. In a systematic review of previously published studies researchers, Edward Mills and colleagues, looked at studies in both developed and developing country settings which had examined the factors that affect adherence to these regimens.
84 relevant studies were examined of which 37 used "qualitative" methods (focus groups, interviews, open-ended questioning) and 47 used "quantitative" methods (surveys). Only 12 of the studies had been carried out in the developing world.
Many barriers to adherence were common to both developed and developing settings, including fear of disclosure of HIV status, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that were too complicated, number of pills required, decreased quality of life, and work and family responsibilities. Factors unique to the studies conducted in the developing world included financial constraints and problems with traveling to get access to treatment.
Important facilitators (factors that made adherence easier) reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretroviral drugs, acceptance of HIV status, understanding of the need for strict adherence, making use of reminder tools, and having a simple regimen. No facilitators to adherence were discussed in any study in a developing nation setting.
The authors conclude that "clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations". However, they note that in developing country settings, "the reliability of medication access is an important adherence barrier that individuals have little opportunity to facilitate. Patient-level adherence can be determined only when a steady supply of medication exists."
Citation: Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, et al. (2006) Adherence to antiretroviral therapy: A systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 3(11): e438.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030438
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-11-mills.pdf
An eLetter will be also published on the 21st November in response to the article. You will be able to view this via the Read Other Responses link.
Curtis Cooper, MD, FRCPC
Associate Professor of Medicine
University of Ottawa
Division of Infectious Diseases
The Ottawa Hospital, Canada
Complement Lysis of HIV In Vivo
The role that humoral immunity plays in fighting HIV infection is complex and poorly understood. In particular, it is not clear whether the complement system helps to stop the spread of HIV or whether it inadvertently helps it to spread by facilitating its entry into macrophages, one of the cell types in which it replicates. Results from Alexandra Trkola and colleagues that antibody-mediated complement lysis of HIV in the laboratory is inversely related to a patient's viral load during acute infection suggest that the complement system contributes to the control of HIV at the early stages. But, because complement levels vary during HIV infections, future work is needed to determine the importance of this form of humoral immunity in combating HIV, particularly since complement has the potential to enhance as well as block viral spread. Nevertheless, the results of this study suggest that complement activating antibodies should be considered in future attempts to design an effective HIV vaccine.
Citation: Huber M, Fischer M, Misselwitz B, Manrique A, Kuster H, et al. (2006) Complement lysis activity in autologous plasma is associated with lower viral loads during the acute phase of HIV-1 infection. PLoS Med 3(11): e441.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030441
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-11-trkola.pdf
University Hospital Zurich
Division of Infectious Diseases
Zurich, ZH 8091 Switzerland
* * * * * * * * EMBARGO: MONDAY, 20 November, 5 P.M. PST * * * * * * *
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