Substance use and the puzzle of adherence.

Abstract

The issues of HIV resistance and its relation to patient adherence to treatment are discussed. Non-compliance or misuse of combination therapy fears are usually directed at a single group, substance abusers. There are differences in the availability and use of HIV treatment by race, gender, and injection drug use status. Those most affected by injection-drug-related HIV disease, and thus from treatment, are Hispanics and African-Americans. Complying with HIV drug treatment regimens can be difficult but it is important since non-adherence to drug therapy, once started, can develop a new strain of HIV that may be resistant to a particular antiviral drug. Unfortunately, twelve years of studies have found non-adherence to be the norm in general medical treatment. Many reasons exist, including the patient's decision to non-comply. Researchers have found that while short-term adherence can be increased with some simple actions, long-term compliance is more difficult and labor intensive. To help long-term compliance, practitioners must understand their patients' belief systems, deliver accurate information to influence beliefs, and in cases when competing demands are compelling, help to reduce distractions. For injection drug users, withdrawal is the chief distraction, and addressing that distraction is a primary negative influence on adherence. Since research cannot identify who will or will not adhere, it is suggested that generic judgments be avoided and HIV treatment be available to all in need.