Breaking Barriers to Medication Adherence in HIV: An Interview With Robert Gross, MD

Robert Gross, MD; Shira Berman


August 05, 2013

In This Article

Adherence in the "Well" Patient

Medscape: It would seem to be easier to implement therapy and maintain higher medication adherence rates in patients who are symptomatic. What are the challenges for HIV-positive patients with higher CD4 counts who are well?

Dr. Gross: Lack of symptoms is a relative barrier to adherence, but it's not specific to HIV. We've seen this in other areas -- patients who have high blood pressure or high cholesterol and have no symptoms have very low rates of adherence to medication.[3]

The problem is that any one barrier may or may not exist for an individual. There are individuals who have high CD4 counts who are very committed to therapy. They buy into the idea of therapy. They are good with their routines, and they have no problem with adherence. Then there are people with very low CD4 counts. They are very sick. They are symptomatic from their HIV disease. If they take their medications, they do better, and yet they don't have good routines to help them stick to a schedule and take their medications.

Paying attention to the individual patient's situation is important. This is one of those barriers to be aware of, but we should be careful not to assume that people with high CD4 counts who are healthy are not going to take their meds and that people with advanced disease will necessarily be more adherent.

In part, it depends on the trust that the patient builds with the provider, how committed the patient is, and whether they believe in the advice that the provider is giving. Studies have shown that believing in conspiracy theories and mistrusting the medical establishment can serve as a barrier to adherence.[4,5] Uncovering some of those beliefs and trying to establish more of a rapport, more of a trust in the provider, is equally important.