A D H E R E N C E

Not many years ago, much was made of the fact that roughly 95% (or better) adherence was needed in order for antiretroviral treatments to remain successful in the face of a constantly mutating (often said to be “sloppy”) virus which, if offered the chance for a breakthrough through reduced adherence, would become resistant to the medications being taken. Obviously, the serious worry was over a reduction in successful treatment options.

In more recent times, there appears to be less made of this adherence figure (without saying that it isn’t still a target, as there is some evidence and, thus, there are some in the community who admit that 95% may be higher than needed); however, acknowledging that at least some high level of adherence is required, what supportive measures can we expect / provide as expanded HAART programs target the more disadvantaged populations in this province in a testing and treatment campaign? The rock and the hard place, on this one, appear to be that either we do or we do not need such strict “take these medications at the time and in the manner directed” instructions, always without fail… and that this is dependent to some degree upon the specific medications and the frequency of dosing (just as it also is an individualized biological issue). Is every individual going to have a different threshold? How is that communicated? The message, here, may seem inconsistent, but in fact we’re aiming for as high an adherence as possible – period. The higher and (to some degree) the lower levels of adherence (in numbers) appear to be better than an irregular off-and-on strategy. In other words, if you’re going to miss, they say it’s better to miss all the time than to hit-and-miss a lot.

What are your thoughts?