People with HIV more likely to adhere to their antiretroviral therapy than treatment for other chronic health problems

Ageing HIV-positive people have significantly higher levels of adherence to their antiretroviral therapy than to medication taken for other chronic health problems, Swiss investigators report in HIV Medicine. The research also revealed that people living with HIV rated the necessity of their HIV treatment more highly than therapy for other illness and also had lower levels of concern about their antiretroviral treatment compared to therapy for co-morbid conditions.

“This is the first study on HIV-infected patients’ beliefs about all their co-treatment in comparison with their cART [combination antiretroviral therapy],” comment the investigators. “It is essential to explore the different beliefs about medicines of comorbid HIV-infected patients which may influence their medication management strategies and decisions to adhere to prescribed regimens.”

The success of antiretroviral therapy means that most HIV-positive people now have an excellent life expectancy. People living with HIV can expect to survive well into old age and therefore require treatment for chronic health problems such as cardiovascular disease, osteoporosis and depression.

Investigators from the Swiss HIV Cohort hypothesised that people would have differing attitudes towards their HIV treatment and therapy taken for other conditions.

They therefore designed a prospective, observational cross-sectional study involving antiretroviral-treated people taking long-term therapy for at least one other chronic health problem. After a routine clinic visit, individuals were asked to complete two standardised questionnaires assessing beliefs about the necessity of their treatment and their concerns about such therapy. The first questionnaire explored beliefs about antiretroviral treatment, the second beliefs about therapy taken for other chronic conditions.

Concerns were rated on a scale from 1 (low) to 5 (high).

Adherence to HIV therapy and treatment was also measured. Adherence was defined as not missing any doses in the previous four weeks.

The survey took place between 2015 and 2016.

The final study sample consisted of 105 people. Three-quarters were men and the median age was 56 years. Half the participants were employed and 26% had a bachelor’s degree or higher. Almost all (97%) had an undetectable viral load and median CD4 cell count was 707 cells/mm³. The major prescribed co-therapies were for cardiovascular disease (79%) and depression (44%).

A significantly higher proportion of people reported being adherent to their HIV treatment compared to therapy for co-morbidities (87 vs 75%, p = 0.0001).

The necessity of antiretroviral therapy was rated much higher than treatment for other chronic health problems (mean scores: 4.46 vs 2.86, p < 0.0001). Individuals without a university degree gave higher scores for co-treatment necessity than those with a degree.

“This counterintuitive result might be a consequence of patients with more education possibly being more likely to question their doctors’ decisions regarding co-treatment choices and believing that they know their disease and treatment options well, and are capable of making educated decisions about their therapy,” suggest the authors.

Overall, patients were more likely to be concerned about their co-medications than their HIV therapy (mean scores: 4.09 vs 2.9, p < 0.001).

Taking two or more co-medications was associated with higher necessity scores (p = 0.041) and increased concerns (p = 0.036). A higher CD4 cell count was associated with a higher co-treatment necessity score (p = 0.016).

“Further research is needed to explore the association between adherence and patients’ perceptions,” conclude the authors. “Although our findings need confirmation, they suggest that it could be important to focus on patient beliefs to improve adherence to co-treatments.”