December 8, 2016 - Curant Health COO, Marc O'Connor, in Specialty Pharmacy Times
The Status of HIV Medication Adherence and Viral Load Suppression
At the end of 2010, the American South accounted for 45% of the estimated 33,015 new AIDS diagnoses in the 50 states and the District of Columbia, followed by the Northeast (24%), the West (19%), and the Midwest (13%).1
Several studies have demonstrated that medication adherence is second only to CD4 count in accurately predicting progression to AIDS and death. For example, in a study of 76 HIV-positive patients that measured adherence by unannounced pill count every 3 to 6 weeks, no patient with >90% adherence progressed to AIDS over the 13-month follow-up period compared with 8% of those with adherence between 51% and 90%, as well as 41% with ≤50% adherence.
In bivariate analysis, each 10% difference in mean adherence was associated with a 28% reduction in the risk of progression to AIDS. Although medication adherence among chronically ill patients, including those with HIV, remains an ongoing issue, we seek to improve every single day in our efforts to improve patient care. Data from the Medical Monitoring Project, presented at the 2016 Conference on Retroviruses and Opportunistic Infections, indicate that the proportion of HIV-positive individuals “in care” with fully suppressed viral loads at their most recent test increased from 72% to 80% between 2009 and 2013.2
It is certain that much work remains to be done to combat HIV and the tens of thousands of new diagnoses every year. Nevertheless, there is reason for optimism through continuing improvements in the “medicine of infectious disease care,” inclusive of remarkable new pharmaceutical therapies, collaborative care, outstanding patient support, and medication management.
Recent Success Stories Offer Reasons for Optimism and Action
Presenting with a CD4 count of only 21, doctors gave Robert W. mere months to live. Weighing only 98 pounds, his HIV had progressed to stage 3 AIDS, and he was on his deathbed. Robert had been prescribed 7 different HIV medications and had a long history of struggling with compliance due to the complexity of his therapy coupled with the financial burdens of high co-pays.
Although he wanted to get better, he had to make decisions on which medications to buy based on what he could afford. Years of treating his condition with this hodgepodge approach left him resistant to many of the medications that could effectively treat his HIV. His roadblocks to adherence reached a crescendo when the loss of a brother he was close to left him hopeless and his inner fortitude to fight began to fade.
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