Script for Ò Better Adherence
for a Better Life!Ó
Hi, my name is [PRESENTER NAME].
IÕm [PRESENTER ROLE]. Welcome to ÒBetter Adherence for a Better Life!Ó This
video is intended for individuals who are HIV positive and are on
antiretroviral medications and will explain why it is so important to take your
medication as prescribed and what can happen if you donÕt or decide to take a
drug holiday. The information in this video can save your life, so please watch
the whole video.
OK. So you are HIV positive and
your doctor has told you to start taking antiretroviral medications (which are
known as ARVs for short). If you take care of your health and follow your
doctorÕs instructions, you will be able to remain healthy and lead a full life
for many years to come.
Once your doctor has prescribed
ARVs, it is important that you understand why you should follow his or her
instructions. This is really important, so please listen.. ARVs do not cure
HIV; they only suppress the virus. Most ARVs interfere with the virusÕs ability
to replicate inside your body. Others block the virus from getting inside your
cells. By taking your medications as prescribed by your doctor, you reduce the
amount of virus in your body, called your viral load, hopefully to a
nondetectable level. This has many benefits.
First of all, reducing the
amount of virus in your body gives it a chance to get strong again. When you
become infected with HIV, the virus begins attacking your immune system,
specifically your immune cells called CD4 cells. Over time, without medication,
the CD4 cells may drop to a very low level. With the appropriate ARVs, the HIV
virus is reduced in the body, allowing it to get strong again. In most cases,
this results in an increase in CD4 cells.
Second, by keeping your viral
load low and CD4 cells higher, you help your body fight off OTHER kinds of
infections. CD4 cells work with other immune cells in your body to help fight
off infections by bacteria, viruses, fungi, and parasites. When a personÕs CD4
count falls too low, they become vulnerable to infections that a healthy
personÕs immune system would fight off. This is why people with end stage AIDS
are often sick. They are more vulnerable to tuberculosis, certain types of
pneumonia, and many other diseases and may die as a result of these other
infections. By keeping your viral load low and your CD4 count high, you will
reduce your risk of contracting other infections that may reduce your quality
of life or even kill you.
Third, taking your medications
as prescribed can prevent a diagnosis of HIV from progressing into a diagnosis
of clinical AIDS. An uninfected individual has about 800 to 900 CD4 cells. A
personÕs diagnosis changes from HIV positive to AIDS when either their CD4
cells fall below 200 or they develop an infection that takes advantage of their
weakened immune system, called an opportunistic infection. If you are HIV
positive but have not been diagnosed with clinical AIDS, do everything you can
to keep it that way.
Fourth, taking your medications
as prescribed reduces the risk that the HIV in your body will develop
resistance to the medication you are on. This can be a difficult concept to
understand, so please listen carefully. The HIV virus is constantly reproducing
itself in your body every day. Antiretroviral medication works to suppress the
replication of HIV. Resistance to the medications develop when there is just
enough medication in the body to Òselectively pressureÓ HIV to change itÕs
genetic sequence, called a mutation, but not enough to suppress the virus. When
there is not a high enough level of antiretroviral medication in the body to
suppress the HIV virus, as in the case of not taking your medications as
prescribed, the virus actually mutates to become resistant to the very
medication that was supposed to suppress it. Recent research has shown that
there are different resistance patterns depending on which class of medication
a patient is taking and how adherent they are to their regimen. Depending on if
you have exceptional adherence, with near perfect levels of compliance, or
moderate to low levels of adherence, you should discuss with your doctor which
class of ARVs is best for you.
A fifth benefit to taking your
ARVs as prescribed is that it reduces the risk that you may transmit HIV to
another person by reducing your viral load. HIV is a 100% preventable illness.
It is important to remember that we all have the opportunity to help stop the
spread of this deadly virus. If you are HIV positive, you have the opportunity
to make sure that HIV stops with you. Taking your medications as prescribed,
however, is no substitute for safer sexual practices. Additionally, if you are
HIV positive with an already resistant virus, and you have unprotected sex, you
may transmit that resistant strain to someone else, leaving them with fewer
options for treatment in the future.
Full compliance includes
understanding how to take your antiretroviral medication. Some ARVs must be
taken with food or on an empty stomach and some shouldnÕt be combined with
certain medications. Remember that Norvir needs to be refrigerated. Make sure
you understand all of your doctorÕs instructions and follow them exactly.
If you feel better after taking
ARVs for a while, that doesnÕt mean itÕs OK to stop taking them or to reduce
your dosage; it generally means that you should stay on the medication so it
keeps HIV in check. There have been a number of studies on stopping ARVs for a
period of time, called a drug holiday. The results of these studies have
repeatedly shown the consequences of drug holidays, namely a more rapid
progression to drug resistance and treatment failure.
People sometimes think that if they develop resistance to one
medication, theyÕll just switch to taking another. ItÕs not that simple. When
HIV develops resistance to one medication, it sometimes develops resistance to
other medications at the same time. And even if you can switch to another set
of medications, the new medications may be more complicated to comply with and
may have side effects you donÕt like. If you develop HIV with enough resistance
to enough medications, you may run out of effective treatment options. So treat
every ARV like the precious and limited resource that it is. Make your current
ARV regimen last as long as possible to keep your options open down the road.
Lets talk about some of the
reasons individuals sometimes donÕt take every dose of their ARVs as prescribed
and what you can do to avoid each problem.
Studies have shown a number of
factors affecting adherence with the three most common being 1) Total number of
pills; 2) Dosing frequency per day; 3) Side effects. It is important to work
with your doctor regarding how many pills and how many times a day you are
willing to take medications. If you are experiencing unpleasant side effects to
the medications you are taking to the point that you want to stop them or
reduce your dosage, talk to your doctor. They can help you determine whether to
treat the side effects, or switch to different ARVs.
People sometimes miss a dose
because they donÕt want their family or friends to know that they are HIV
positive. Stigma and discrimination not only contribute to the spread of HIV,
but also to the isolation some individuals feel when they are HIV positive. It
is important to remember that you are not alone. Find an HIV support group
where you can share common problems and find solutions.
People sometimes miss a dose of
medication because they travel or stay overnight with a friend or sexual
partner and forget to take their medication with them. If you think itÕs even
possible that you might not return home on your regular schedule, make sure to
take your medications with you.
People sometimes miss a dose
because they use alcohol or drugs and this makes it hard for them to remember
to take their medications. If your use of alcohol or drugs is interfering with
your ability to take your medication, talk with your doctor about whether a
substance treatment program might be right for you. ItÕs probably a good idea
to talk with your doctor anyway if you are using drugs or alcohol.
People sometimes miss a dose of
ARVs because they are suffering from depression, affecting their ability to
take their medications. If you are feeling depressed, talk with your doctor
about treatment options.
People sometimes miss a dose
because they forget to refill their prescription and run out of medication.
Keep track of how many pills you have left and make sure not to leave refills
to the last minute.
No matter who you are, you are a
valuable individual, and your life matters, as do the lives of those in your
community. Take care of yourself and those around you by taking your
antiretroviral medications as prescribed by your doctor and encouraging those
in your community to do the same.
This is [PRESENTER NAME].
Script by Eric Krock of
AIDSvideos.org and Becky Kuhn, M.D. of Global Lifeworks.
This script was reviewed for
accuracy and approved by Becky Kuhn, M.D. on May 4, 2007.
References:
1) AVERT.org. ÒContinuing
Antiretroviral Treatment,Ó http://www.avert.org/conttrt.htm
2) David R. Bangsberg, M.D., M.P.H. ÒAdherence, Viral Suppression, and
Resistance to Antiretroviral Therapy,Ó in ÒAdherence: The AchillesÕ Heel of
Effective Antiretroviral Therapy,Ó The AIDS Reader Vol 17 No.4 April 2007
Supplement.
3)
Molly Cooke, M.D., ÒDrug Resistance: What It Is, How It Develops and What You
Can Do to Prevent It,Ó
http://www.thebody.com/hivnews/aidscare/june98/pullout.html
4) The National AIDS Control
Program, Ministry of Health, Government of Pakistan , ÒGuidelines for the Use
of Antiretroviral Therapy in HIV Positive Adults and Adolescents in Pakistan,Ó
http://www.nacp.com.pk/pdf/ARV%20Guidlines.pdf
5) Wikipedia. ÒAntiretroviral
drug.Ó http://en.wikipedia.org/wiki/Antiretroviral_drug