Global Positive Perspectives research shows increased treatment choices may help improve self-reported health outcomes in people living with HIV

While improvements in HIV care have been made, some people living with HIV still struggle with their HIV treatments. Results from the Positive Perspectives study highlighted barriers to adherence, and authors noted these may be addressed through increased treatment choices, particularly options that are simplified or less conspicuous parts of the lives of people living with HIV, could help improve self-reported health outcomes.1

Published data from Positive Perspectives show that some people living with HIV still struggle with their daily oral antiretroviral therapy (ART). For this group, the result of this struggle may be suboptimal adherence*, or not conforming with the healthcare provider’s (HCP) recommendations for medication dosage and frequency.1 Suboptimal adherence in HIV is known to impact disease progression, transmission and the development of treatment resistance.2,3,4

Nearly 1 in 4 (24%, n=575/2389) people living with HIV in the Positive Perspectives study reported suboptimal adherence.1

  • Those who reported emotional or psychosocial challenges with daily oral therapy, including fear of unwanted sharing of their HIV status, had higher odds of reported suboptimal adherence to daily oral ART 
  • Those study participants who reported being told that Undetectable = Untransmittable (U=U) by their HCPs had lower odds of reported suboptimal adherence than those who reported not being told about U=U by their HCPs
  • Groups within the study who reported poorer adherence than other study participants included those who reported polypharmacy (defined in the study as taking five or more pills per day or medications for five or more health conditions), those reporting experiencing gastrointestinal side effects from their medicines and, those who reported not being informed about the benefits of adherence by their HCPs
Looking into the reasons for suboptimal adherence reported by people living with HIV in the Positive Perspectives study, feelings of depression/being overwhelmed (7%, n=176/2389), a desire to forget about having HIV (7%, n=168/2389), and work (6%, n=145/2389) were the top reported reasons for missing daily oral ART for ≥5 times per month. Those study participants who reported multiple reasons for missing daily oral ART had higher odds of self-reported virologic non-suppression. 1

The Positive Perspectives study authors suggest that a possible strategy for reducing treatment challenges for those who are struggling with suboptimal adherence may be offering treatments that reduce the need for daily dosing: “Simplifying HIV regimens so they are a less conscious or conspicuous part of patients' lives … may improve adherence and health outcomes.”1

The Positive Perspectives study is one of the largest, global, HIV patient-reported outcomes (PRO) studies to date, with 2,389 people living with HIV participating from 25 countries. The research was created to investigate how people living with HIV rate their own health, how living with HIV impacts their lives and affects their outlook for the future, as well as examining their interactions and relationships with healthcare providers and their experiences with ART.

*In the Positive Perspectives study, suboptimal adherence was defined as a report of ≥1 reason for missing ART ≥5 times within the past month.

References:

  1. de los Rios P, Okoli C, Punekar Y, Allan B, Muchenje M, Castellanos E, Richman B, Corbelli G M, Hardy W D, Young B, Van de Velde N; Prevalence, determinants and impact of suboptimal adherence to HIV medication in 25 countries; Preventive Medicine 139 (2020) 106182
  2. Gross R, Yip B, Lo Re III V, Wood E, Alexander C, P. Harrigan P R, Bangsberg D R, Montaner J S G, Hogg R S; A Simple, Dynamic Measure of Antiretroviral Therapy Adherence Predicts Failure to Maintain HIV-1 Suppression; The Journal of Infectious Diseases 2006; 194:1108–14
  3. Glass T, Sterne J A C, Schneider M-P, De Geest S, Nicca D, Furrer H, Gunthard H F, Bernasconi E, Calmy A, Rickenbach M, Battegay M, Bucher H C, the Swiss HIV Cohort Study; Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality; AIDS 2015, Vol 29 No 16
  4. Lepik K, Harrigan P R, Yip B, Wang L, Robbins M A, Zhang W W, Toy J, Akagi L, Lima V D, Guillemi iS, Montaner J S G, Barrios R; Emergent drug resistance with integrase strand transfer inhibitor-based regimens; AIDS 2017, 31:1425–1434