HIV/AIDS Treatment and Care : Clinical protocols for the European ...

PATIENT EVALUATION AND ANTIRETROVIRAL TREATMENT FOR ADULTS AND ADOLESCENTS
• Early follow-up should occur two days after initiating or changing a regimen, to evaluate whether
the patient needs more information or has unregistered problems.
• The partnership between clinics and community-based organizations can improve the uptake of
information, especially among hard-to-reach populations and some ethnic groups.
4.3.1.3. Regimen factors and strategies
• Dosing more than two times a day is associated with lower adherence levels (79), while there
is probably no adherence difference between one or two daily doses (80). In regimens with
single or double daily dosing, more of the doses are taken at a time. Taking the dose later than
prescribed has been associated with treatment failure in multivariate analysis (81).
• A low pill burden is associated with the likelihood of having a viral load below 50 copies/ml
after 48 weeks (80).
• Adherence levels are not correlated with any ARV class. However, conflicting dietary rules for
different drugs can be a problem (82).
• Harmful drug interactions and side-effects can influence adherence. Doses can be missed due to
vomiting or diarrhoea, and fatigue can cause patients to sleep past doses (83).
Methods to support adherence include:
• evaluating lifestyle factors like eating, sleeping and working patterns and adjusting the regimen
accordingly;
• assessing individual preferences for regimen characteristics such as pill size, formulation, burden,
dietary restrictions, etc.;
• showing patients the pills prior to regimen selection;
• education about side-effects, prompt palliation of them and information about support;
• dispensing medication in small amounts at frequent intervals, which can facilitate:
° opportunities to address adherence problems before they lead to resistance;
° limiting treatment disruptions and misuse;
• utilization of once-daily options and FDCs, which can lower the pill burden and be beneficial
early in treatment; and
• directly observed treatment (DOT), particularly in hospitals.
4.4. ART success and failure
All patients should be regularly monitored by skilled clinicians. Ideally all should have access to
both immunological and virological tests. Successful ART can be defined by clinical, immunological
or virological criteria (see Table 8).
Table . Criteria for treatment success
Virological Immunological Clinical
Marker Viral Load CD4 cell count Clinical stage
Time a 24 weeks 48 weeks 24–48 weeks By 12 weeks of treatment initiation
should be asymptomatic or have few
symptoms
Suggested
ranges a