Family Practice Vol. 18, No. 4, 463
© Oxford University Press 2001
Encouraging adherence to antiretroviral drug regimes
Philip Hay, Department of Genito-urinary Medicine, and Pippa Oakeshott, Department of General Practice, St George's Hospital Medical School, London, UK
Aneet K Sian, 94 Coverton Road, London SW17 0QN, UK.
Tomlinson et al. found that 53% of HIV-positive patients would like their GP to be involved in their care.1 An important role for the GP might be encouraging adherence to antiretroviral drug regimes. In 1998, we conducted a pilot study investigating adherence with antiretroviral drug regimens in consecutive HIV-infected patients attending the St George's Hospital genito-urinary clinic.
Altogether 33 patients were interviewed (28 male and five female). No one refused to take part in the study. The mean age for males was 41 (range 31–58 years) and the mean age for females was 33 (range 28–38 years). Twenty patients were Caucasian and 13 from ethnic minorities, mainly Black African. The patients were of varying stage of disease, with CD4 counts ranging from 75 to 848 x 106/l. The mean number of years since diagnosis with HIV was 3.5 (range 8 weeks to 15 years). The mean number of antiretrovirals being taken was 3.2 (range 2–4).
Twenty-seven per cent of the patients reported that they had missed a dose within the last 2 days, and a further 27% within the last week. An additional 12% missed a dose within the last month and 21% had missed a dose more than a month ago. Only 12% said that they had never missed a dose.
The most common reason given for non-adherence was practical difficulties (38%) such as taking the drugs with or without food; going out and leaving the drugs at home; difficulties with timing whilst travelling abroad; drugs running out; sleeping through the dose. One patient's Ritonavir melted on holiday! The next most common reason was simply forgetting to take the drugs (28%). A further 14% said that side effects caused them to miss doses, and some patients misunderstood the dosing regimen (10%). Another 10% missed a dose due to psychological problems such as stress and depression.
Some of these difficulties might have been overcome by consultation with a sympathetic GP. We agree with Tomlinson et al. that as the management of HIV becomes increasingly complex, there is a need for more involvement of GPs and good collaboration between GPs and specialist HIV treatment centres.
Reference
1
Tomlinson DR, Colebunders R, Coppieters Y et al. Primary care involvement in human immune deficiency virus infection— a pan-European view. Fam Pract 2000; 17: 288–292.
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