compiled by Martin Flynn
PN HEALTHYLIVINGNEWS
New research suggests our ability to stick to HIV meds depends
on whether we believe they are doing us any good
The
fact that most people with HIV will have to take antiretroviral drugs for
the rest of their lives is necessary to maintain health but it can also be
an absolute pain in the arse. People with HIV are expected to take over 95
per cent of their drugs on time and in the correct doses otherwise they could
develop drug resistant virus.
Great expectations
This is an adherence rate much higher than for other diseases, such as cancer
or heart disease, where rates rarely rise above 50 to 60 per cent.
HIV drug regimes are now much easier to take than they were five or 10 years
ago, with fewer pills, fewer interactions and side effects which are predictable,
if not necessarily easier to deal with.
Two eminent psychologists have attempted to delve into our minds to find out
why some of us accept HIV treatments and why others refuse to take them or
simply forget.
Speaking at the National HIV Nurses Association (NHIVNA) conference in Bristol
in June, Professor John Weinman of King’s College London, explained
that non-adherence to medications was a huge problem, not just in HIV medicine,
but right across the health service. A staggering 50 per cent of all drugs
prescribed for long-term medical conditions in Britain are not taken as directed,
he explained. This is not just a huge financial loss for the NHS but is also
a major health risk for the individual patients who miss their drugs.
Adhering is believing
And there is no specific ‘type’ of patient who is good, or not
good, at taking their drugs. Adherence is unrelated to any personality factors,
age, race, gender, or occupation. And rates vary between patients on similar
drug regimes and with the same patient over time.
Professor Weinman insists that a lack of knowledge on treatment information
doesn’t affect adherence either. What really matters is our beliefs.Some
people unintentionally non-adhere to their drugs; they either forget or are
unable to take them. Others are intentionally non-adherent and lack the motivation
and belief that the medicines will do them any good. Our beliefs can predict
the outcomes of our treatments and these beliefs are not set in stone and
change over time.
Professor Rob Horne of the University of Brighton, says most doctors and health
professionals could not understand why some patients didn’t take their
drugs especially when they were proven to be successful at beating disease.Research
at Dr Martin Fisher’s Brighton clinic tracked 136 patients with HIV.
A quarter refused HIV treatments and said they perceived they had a lower
need to take HAART. People with higher CD4 counts or who had spent a longer
time without treatments were the most likely to refuse.
Doubting doctors and drugs
What matters to patients is the trade off between need for the drugs versus
concerns about what the drugs will do inside the body. Some people don’t
like taking any meds and postpone taking them until they absolutely have to.
But what is fascinating about the Brighton research was that adherence
did not improve over time but actually got worse and that it is our beliefs
in what we think is good, or bad, for us which determines how we do. Side
effects or a lack of perceivable improvement in the way the patients felt
about their health were factors in whether the Brighton HIV patients continued
to adhere or not.
Some distrust all medications, others distrust their doctors, and even those
who accept HIV treatments initially may change their views over time.One of
the major problems in the past was that doctors did not explain side effects
to HIV medications in advance. Many patients didn’t know what to expect
or how to cope. They then got a series of horrible toxicities and side effects
and many stopped taking their medicines. In conclusion, being upfront with
patients, explaining possible problems in advance and coming up with practical
solutions to make taking HAART easier to cope with is the key to success among
patients on HIV treatments.
