Ellen Campbell Grizzle - Pharmacy Today REMARKABLE PROGRESS has been made in reducing the prices and expanding the generic options of the antiretrovirals (ARVs) used to treat HIV. Despite improved availability and accessibility, Caribbean pharmacists agree that adherence remains the Achilles heel in efforts to achieve successful treatment outcomes. Indeed, having access to medication is one thing but getting persons to adhere to treatment plans is far more difficult.
Non-adherence related to ARVs leads to medication resistance and disease progression. Resistance occurs when the virus makes "copies" that are "invisible" to the medication. These mutants become large populations on which the drug is ineffective. "Cross resistance" also occurs when all drugs in a class may not work. Switching is therefore required. However, frequent switching leads to the exhaustion of treatment options. This is clearly a bad situation for the individual.
Jamaican patients approach taking HIV medication with several misgivings. They fear breach of confidentiality, the number of tablets that they must take per day and side effects. Many worry about being able to afford treatment over a prolonged period. However, it is important to understand that the benefits far outweigh the cost and that ARVs have a proven track record of suppressing viral load, preserving immune function and improving the quality of life of persons living with HIV/AIDS.
There is no doubt that ARVs are strong and powerful drugs. Many interfere with the pathway by which several drugs are commonly broken down. Drug interactions are a real possibility. If you are a person who takes HIV medication, the more you know about the following should help to motivate you to adhere to therapy:-
The way each drug that you are taking works
The correct method for taking your medication (avoid incorrect dosing and take with or without food as directed)
Side effects and how to alleviate them
How cues support adherence (use daily habits such as watching favourite television show or first visit to the bathroom to trigger dosing)
The role of reminders, timers or alarms, written medication schedules, colour coding and other support systems
The way that the abuse of alcohol, tobacco and other substances, over-the- counter medication and herbal medicines interact with HIV medication
Condom use and other prevention strategies.
It is well recognised that the best treatment plans are developed when patient and doctor work together. Pharmacists can assist with an adherence plan, tailored to your lifestyle, to help to make sure that you take the right amount of medicine, at the right time , in the right way, all the time. Remember, you are not adherent if you fail to take your medication even on vacation; stop taking medication because of side effects; add over-the-counter or herbal medicines to your treatment without consultation with your doctor; change your medication or dosage regimen without consultation with your doctor; engage in risky behaviours such as unprotected sex and drug abuse.
Adherence helps to avoid resistance and slows disease progression. Pharmacists report that initially patients adhere to treatment and are eager for information about new treatment options. However, with time, several suffer "pill fatigue", become overwhelmed by the demands of treatment on their lives, believe that opportunistic infections are drug side effects, get depressed and increasingly despondent. At such times, the support of family, healthcare providers and the wider community is crucial in keeping them on track.
The pharmaceutical industry continues to search for a cure for HIV/AIDS. In the interim, persons living with HIV can use ARVs as an important part of a strategy to improve the quality of their lives. If you want to know more about how ARVs work or need to talk about an adherence plan, ask your pharmacist, you have the right to know!
Ellen Campbell Grizzle, President of the Caribbean Association of Pharmacists (CAP) and Director, Information & Research, National Council on Drug Abuse (NCDA), Kingston, Jamaica.
