No currently available screening tools can reliably prospectively identify those individuals who will be either adherent or nonadherent

No currently available screening tools can reliably prospectively identify those individuals who will be either adherent or nonadherent. problems.1 Untreated HIV infection causes progressive deterioration of the immune system (ie, AIDS), which results in substantial morbidity and mortality. Efficacious antiretroviral (ARV) treatment has transformed HIV, once considered invariably fatal, into a chronic manageable disease; however, nonadherence has emerged as a major barrier to successful treatment of this disease. The positive impact of ARV therapy, in developed countries, has been striking. The median life expectancy for a 25-year old newly HIV-infected individual who has access to ARV treatment is an additional 39 years.2 Large observational cohort studies have shown that starting ARV sooner in the course of HIV disease is associated with a significant reduction in mortality.3 Furthermore, ARV therapy also decreases complications from HIV-associated inflammation and significantly reduces the risk for transmission of HIV in serodiscordant couples.4 ARV treatment has become so effective that a strategy to use universal HIV testing and early initiation of ARV therapy as a method of eradicating the disease has been proposed.5 These overwhelming benefits of ARV therapy, Famprofazone coupled with its cost-effectiveness, led to the December 1, 2009, Department of Health and Human Services (DHHS) recommendation to start ARV treatment earlier in the course of HIV disease.6 Thus the number of individuals who are prescribed ARV therapy has increased, and strategies for enhancement of adherence in this growing population require careful attention. Numerous studies have shown that the key to HIV treatment success is usually suppression of HIV viral load by ensuring that HIV-infected individuals not only have full, uninterrupted access to ARV medications but also take them consistently every day of their lives.6 Interruptions in ARV therapy and missing medication doses are associated with a high risk for nonsuppressed HIV viral load, leading to drug resistance and consequent treatment failure.7 Individuals who develop drug resistance due to suboptimal adherence (ie, nonadherence) to their ARV medication regimens are challenging to treat, require more complex and costly ARV medication combinations to suppress HIV viral load, are hospitalized Famprofazone significantly more frequently than their adherent counterparts, 8 and experience extremely poor health outcomes and low quality of life.9,10 Although new ARV medications are more forgiving (ie, do not seem to require such strict adherence as was necessary with older ARV regimens),11 the ability to take ARV medications consistently remains the key factor in ensuring positive HIV-related health outcomes and improving quality of life.12 The problem of nonadherence to HIV treatment While many HIV-infected individuals are able to successfully take their ARV medications as prescribed, over one-third (37%) of HIV-infected persons in developed countries have difficulty maintaining adequate levels of adherence.13 Although developing countries have reported lower rates of nonadherence, newer studies have indicated that this problem of nonadherence is global.14 The inability of clinicians to predict adherence among their patients has been disappointing. No currently available screening tools can reliably prospectively identify those individuals who will be either adherent or nonadherent. Adherence is Famprofazone usually highest among treatment-na?ve individuals, who are presumably more motivated and less fatigued with their medication regimens. Adherence is enhanced IkB alpha antibody by the use of potent antiretroviral regimens with a low daily pill count, especially when prescribed either once or twice a day.15 The nonadherent subset of the HIV population has presented one of the most daunting challenges in the successful long-term management of HIV disease. The etiology of nonadherence is generally multi-faceted, as will be discussed below. Nonadherence promotes the development of drug resistance mutations and necessitates use of more complex ARV regimens.9 Individuals who are nonadherent to ARV medications experience immune system deficiency and develop persistent debilitating constitutional symptoms such as fevers, night sweats, weight loss, and diarrhea.16 Their risk for life-threatening opportunistic infections increases.16 Further, untreated HIV causes an inflammatory process that damages vital organ systems resulting in increased morbidity. 17 Finally, HIV-infected individuals with nonsuppressed HIV viral load are at much higher risk for transmitting HIV to others.4 In addition to the negative impact of nonadherence on individual health, the financial burden of nonadherence is also substantial. As HIV-infected individuals fail ARV regimens, each subsequent medication regimen becomes not only more complex but also more costly because a greater number of medications are needed to suppress HIV viral load.18 The ARV medications currently available to treat HIV.