Side effects are a common cause of intentional non adherence to HAART

Patient adherence to and persistence with highly active antiretroviral therapy (HAART) are crucial factors in achieving virologic and immunologic success and avoiding resistance. Numerous studies have evaluated the reasons why patients “accidentally” miss doses of HAART, but few have evaluated the reasons why patients intentionally skip doses.

In a study in the Journal of Acquired Immune Deficiency Syndromes, investigators attempted to estimate the frequency and possible predictors of intentional non adherence to HAART. The study was a cross-sectional survey of a population of patients on HAART, all of whom received their medications free of charge, in British Columbia, Canada. The participants completed surveys on an annual basis and the 638 patients involved in this study were those patients who responded to the survey between 1 January and 1 November, 2001.

Patients reported that they had experienced 42 different side effects of antiretroviral agents. These side effects were grouped by the investigators by whether they were considered subjective or objective and whether they would or would not prompt clinical action. For the purposes of the study, intentional non adherence was defined as the patient skipping or altering doses of their antiretroviral regimen, without the recommendation of their physician, due to an adverse drug effect.

Of the patients enrolled in the study, 70 (11%) reported intentional non adherence with between 4% and 7.4% reporting this activity over the preceding year depending on the symptom group. A multivariate analysis showed that a plasma viral load of <400 copies/mL and completion of high school were both inversely associated with intentional non adherence.

In addition, the investigators found that those patients who reported at least one severe symptom were more than twice as likely to report intentional non adherence. Finally, each additional objective side effect that required clinical action was associated with a 25% increase in the risk of intentional non adherence.

The authors conclude: “Intentional non adherence to antiretroviral therapy is common among persons experiencing therapy-related side effects. Although the type and severity of adverse effects impact intentional non adherence, this activity occurs in relation to symptoms regardless of their strict clinical relevance.”

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