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Why Adherence Matters When Treating HIV

How antiretroviral therapy (ART) works to treat HIV, and why viral suppression depends on taking every dose.

To maintain viral suppression, ART medications must be taken continuously for the rest of a person’s life.

The key to successful HIV treatment is adherence. Adherence means “sticking to something.” In medicine, the term adherence refers to a person’s ability to follow a treatment plan outlined by a healthcare provider.

In the treatment of HIV, adherence means starting treatment, taking all doses of HIV medication, and attending all appointments with your healthcare providers. Adherence is an important topic to discuss with a healthcare provider when beginning treatment. Non-adherence can have long-term negative effects on HIV treatment and a person’s health.

Understanding HIV

Known as HIV, human immunodeficiency virus is a viral infection that infects and destroys CD4 cells. CD4 cells are a type of white blood cell that the body’s immune system needs to fight infections.

Over time, as the immune system has fewer and fewer healthy CD4 cells—and more HIV-infected CD4 cells—the body is unable to defend itself against bacteria, viruses, and the proliferation of certain types of cancer cells. This can lead to many complications, including AIDS (acquired immune deficiency syndrome).

AIDS is the late stage of HIV infection, where the immune system is severely damaged and unable to fight off serious opportunistic infections. A person with AIDS can still be treated with HIV medications. Untreated, a person with AIDS has a life expectancy of roughly 3 years.

Understanding HIV treatment

There is no cure for HIV, but there are treatments that are very effective at suppressing the virus. The standard of HIV treatment is antiretroviral therapy, or ART. Antiretroviral medications work by disrupting the lifecycle of the HIV virus.

Typically, a person is prescribed a combination of different ART medications, which act on the virus in different ways. This offers the best chance of lowering the viral load (the amount of virus in the body) to the lowest levels possible—ideally, so low that HIV cannot be detected with a standard blood test. A combination of HIV medications a person is prescribed is called a regimen.

A person with HIV who adheres to their prescribed treatment regimen can live a long and healthy life, though they are at an increased risk of conditions like cardiovascular disease, type 2 diabetes, and cancer, especially as they age.

The importance of adherence

ART medications are very effective at reducing the amount of virus in the body—but they cannot get rid of the virus completely. To maintain viral suppression, ART medications must be taken continuously for the rest of a person’s life.

Taking ART medications inconsistently, skipping doses, or stopping ART medications can lead to problems:

  • Viral load increase. This means the HIV infection will begin to infect and destroy CD4 cells, leaving the body more vulnerable to infections and cancers that can seriously damage a person’s health, and in some cases, lead to death.
  • Transmission. An increased viral load also increases the risk of transmitting the virus to others. Because there is more virus in the body, there is more virus that can leave the body and infect another person.
  • Drug resistance. By preventing the virus from replicating, ART medications prevent the virus from mutating. Mutations can lead to drug resistance, where some ART medications are no longer effective at stopping the virus from replicating. This makes re-starting treatment more difficult—and potentially less effective.

Treatment for HIV is a lifelong process, which means that the challenges of adhering to HIV treatment can change over time. Always tell your healthcare provider about any circumstance that has the potential to interfere with HIV treatment—a change in job, in insurance, in your day-to-day schedule, a change in your mental health.

Also, always be honest with your healthcare provider. If you are having a hard time following your treatment or have missed doses, share this information. Your healthcare providers need to know these details in order to provide you with the best care possible.

Article sources open article sources

National Institutes of Health. HIV Treatment Adherence.
MedlinePlus. HIV.
NYU Langone Health. Diagnosing HIV Infection & AIDS.
MedlinePlus. CD4 Lymphocyte Count.
HIV.gov. What Are HIV and AIDS?
Centers for Disease Control and Prevention. HIV Treatment.
UpToDate. Patient education: Initial treatment of HIV (Beyond the Basics).
National Institutes of Health. What to Start: Choosing an HIV Treatment Regimen.
HIV.gov. Aging with HIV.
Linda Beer, Yunfeng Tie, John Weiser, and R. Luke Shouse. Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), 2019. Vol. 68, No. 49.
World Health Organization. HIV drug resistance.

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