Re: Adherence to generic ARV medication at a Tertiary Center in North India

[Guest guest]

Dear FORUM,

Re: Dr Ajay Wanchu et al " Study on Adherence to generic ARV medication at a

Tertiary Center in North India "

I wonder about the " factual basis " of 95% adherence necessary for therapy to

work. Obviously adherence needs to be high for therapy to work. But, in my

opinion it makes no sense to assume that exactly the same degree of adherence is

necessary for each different ARV medication.

For example perhaps 90% adherence is necessary for Nevaripine to work

effectively in " most " people, while 97% adherence is necessary for Duovir (AZT +

3tC). That fact that 147 people stated that they had complied completely is

quite remarkable, and I am happy here about it.

In what way, is " required adherence " also effected by Viral Load and CD4 count.

Perhaps a person whose Viral Load has been close to zero for a long period of

time could afford an occasional " lapse " of adherence without doing much damage

to their overall treatment, whereas a person who begins treatment with very high

VL, and near zero CD4, obviously cannot afford to be " non adherent. "

Sometimes, I'm afraid health care workers make decisions remove PLWA from

treatment based on " non-adherence " without making a totally scientific

assessment of what " non-adherence " really is.

All PLWA who are assumed by health care staff to be " non-adherent, " should be

offered counseling, and support. An attempt should

be made to analyze the factors that have contributed to their non-adherence. At

times peer support groups, in a safe, confidential setting can be quite

effective for supporting adherence.

Below, for example if there is either " drug toxicity " or " adverse effects " (I am

not sure of the difference) an attempt should be made to find out what these

effects are, and to offer a change of medications if necessary.

However, we also know that in many cases, adverse secondary effects appear,

especially during early stages of treatment, and then disappear. But many

patients do not necessarily know that, unless they have been adequately

counseled.

Finally, it seems important to avoid stigmatization about " anticipated

adherence, "

For example in many developing countries it is not uncommon for sex workers,

persons with alcohol and drug problems, homosexuals, and " homeless " people to be

denied access to treatment because

they are considered " poor risks " for adherence. This is a very dangerous

thinking and violates the human rights of these individuals.

Some of these individuals may need additional counseling and support to improve

their adherence, but they should never be denied treatment on the basis of

arbitrary factors related to their " life-style. "

Stern

E-mail: <rastern@...>