Script for “ Better Adherence for a Better Life!”
Hi, my name is [PRESENTER NAME]. I’m [PRESENTER ROLE]. Welcome to “Better Adherence for a Better Life!” 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 don’t 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 doctor’s 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 virus’s 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 person’s CD4 count falls too low, they become vulnerable to infections that a healthy person’s 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 person’s 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 “selectively pressure” HIV to change it’s 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 shouldn’t be combined with certain medications. Remember that Norvir needs to be refrigerated. Make sure you understand all of your doctor’s instructions and follow them exactly.
If you feel better after taking ARVs for a while, that doesn’t mean it’s 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, they’ll just switch to taking another. It’s 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 don’t 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 don’t 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 don’t 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 it’s 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. It’s 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.
1) AVERT.org. “Continuing
Antiretroviral Treatment,” http://www.avert.org/conttrt.htm
2) David R. Bangsberg, M.D., M.P.H. “Adherence, Viral Suppression, and Resistance to Antiretroviral Therapy,” in “Adherence: The Achilles’ Heel of Effective Antiretroviral Therapy,” The AIDS Reader Vol 17 No.4 April 2007 Supplement.
3) Molly Cooke, M.D., “Drug Resistance: What It Is, How It Develops and What You Can Do to Prevent It,” http://www.thebody.com/hivnews/aidscare/june98/pullout.html
4) The National AIDS Control Program, Ministry of Health, Government of Pakistan , “Guidelines for the Use of Antiretroviral Therapy in HIV Positive Adults and Adolescents in Pakistan,” http://www.nacp.com.pk/pdf/ARV%20Guidlines.pdf
5) Wikipedia. “Antiretroviral drug.” http://en.wikipedia.org/wiki/Antiretroviral_drug