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 for people who are HIV positive and who are on AIDS medications. It will explain why it is so important to take your medications as prescribed and what can happen if you don’t or if you 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 AIDS medications (which are known as antiretroviral medications, or ARVs for short). If you take care of your health and follow your doctor’s instructions, you may be able to remain healthy and lead a full life for many years to come. 

Once your doctor has prescribed AIDS medications, it is important that you follow his or her instructions. AIDS medications do not cure HIV. They only suppress HIV. Most AIDS medications interfere with HIV's ability to copy itself inside your body. Others block HIV from getting inside your cells. By taking your medications as prescribed by your doctor, you reduce the amount of HIV in your body, called your viral load, hopefully to a nondetectable level. This has many benefits.

First, reducing the amount of HIV in your body gives your body a chance to get strong again. When you become infected with HIV, HIV begins attacking your body's ability to fight infections. In particular, it attacks disease-fighting cells called CD4 cells. Over time, without medication, the CD4 cells may drop to a very low level and the body's ability to fight off infections is reduced. With the appropriate AIDS medications, the amount of HIV in your body is reduced, allowing your body to get strong again. In most cases, this will increase the number of CD4 cells in your body.

Second, by keeping the amount of HIV in your body low and your CD4 cell count higher, you help your body fight off other kinds of infections. CD4 cells help fight off infections. When a person’s CD4 count falls too low, they become vulnerable to infections that a healthy person’s body 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 additional infections. By keeping the amount of HIV in your body 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 person who is not infected with HIV has a CD4 cell count of about 800 to 900. 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, which is called an opportunistic infection. If you are HIV positive but have not been diagnosed with clinical AIDS, do everything you can to avoid progressing to clinical AIDS.

Fourth, taking your medications as prescribed reduces the risk that the HIV in your body will develop resistance to the medication you are on. HIV is constantly copying itself in your body every day. AIDS medications work to stop HIV from copying itself. When there is some medication in the body but not enough, HIV may change and develop resistance to the medication. This is called a mutation. When this happens, HIV becomes resistant to the very medication that was supposed to stop it. That's why it's so important to take every dose of your medication exactly as the doctor prescribed. This will keep the amount of medication in your body high enough and will reduce the risk that HIV will become resistant to the medication. Discuss with your doctor which medications are best for you.

Fifth, taking your medications as prescribed will reduce the risk that you may transmit HIV to another person. AIDS medications reduce the amount of HIV in a person's body. The less HIV there is in a person's body, the lower the risk that they will transmit HIV to others. People treated with AIDS medications are only one twenty-fifth as likely to transmit HIV to others. HIV is a 100% preventable illness. We all can help stop the spread of this deadly virus. If you are HIV positive, you can help make sure that HIV stops with you. Remember that even if you are taking your medications as prescribed, you still need to practice safer sex. This is true even if your sexual partner is already HIV positive. If you are HIV positive and your HIV is resistant to some medications and you have unprotected sex, you may transmit that resistant strain of HIV to your sexual partner, leaving them with fewer options for treatment in the future.

To take your medication as prescribed, you must understand HOW to take the medication. Some medications must be taken with food or on an empty stomach, and some shouldn’t be combined with certain other medications. The AIDS medication called 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 AIDS medications 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 under control. There have been a number of studies about the effect of stopping AIDS medications for a period of time, which is called a drug holiday. These studies have repeatedly shown that stopping taking your AIDS medications  causes HIV to develop resistance more quickly and treatment to fail sooner.

People sometimes think that if their HIV develops resistance to one medication, they’ll just switch to taking another medication. 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 AIDS medication like the precious and limited resource that it is. Make your current AIDS medications last as long as possible to keep your options open down the road.

Let's talk about some of the reasons people sometimes don’t take every dose of their AIDS medications as prescribed and what you can do to avoid each problem.

A number of things influence how well patients do at taking their AIDS medications as prescribed.  Three common issues are: 
1) how many total pills the person must take each day; 
2) how many times the person must take medications each day; 
3) side effects the person experiences 
Work with your doctor regarding how many pills you are willing to take and how many times a day you are willing to take medications. If you are experiencing unpleasant side effects to the medications to the point that you want to stop the medications or reduce your dosage, talk to your doctor. They can help you determine whether to treat the side effects or switch to different medications. 
 
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. 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 their medication because they are suffering from depression. 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. As a last resort, in some places, pharmacies may be able to give you an emergency partial refill of your AIDS medication, even if your prescription hasn't been renewed. But don't count on this. Make sure you don't run out of your medications! 

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 AIDS medications as prescribed by your doctor and encouraging those in your community to do the same.

This is [PRESENTER NAME].

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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 July 30, 2011.

References:
1) AVERT.org. “Starting, monitoring & switching HIV treatment.” http://www.avert.org/antiretroviral.htm Accessed 30 July 2011.
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 Accessed 30 July 2011.
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
6) McNeil, Donald G., Jr. "Early H.I.V. Therapy Sharply Curbs Transmission." 12 May 2011 New York Times. http://www.nytimes.com/2011/05/13/health/research/13hiv.html. Accessed 25 July 2011.