Monitoring Adherence to HIV Antiretroviral Therapy in Routine Clinical Practice: The Past, the Present, and the Future

Excerpt

Adherence to antiretroviral therapy is the strongest predictor of viral suppression, drug resistance, disease progression and death in HIV infected individuals (Bangsberg et al., 2000, 2003; Bangsberg, Hecht et al., 2001; Bangsberg, Perry et al., 2001; de Olalla et al., 2002; Hogg et al., 2002; Paterson et al., 2000). There is, however, no standard approach to adherence assessment in routine clinical practice. This situation is analogous to the general internist managing hypertension with out a blood pressure cuff or the critical care specialist managing a ventilator without measures of oxygenation. Worse yet, providers in routine clinical practice have rarely predicted adherence better than random (Bangsberg, Hecht et al., 2001; Bangsberg, Perry et al., 2001; Gross, Bilker, Friedman, Coyne, and Strom, 2002) which means that we are leaving the most critical determinant of HIV treatment outcomes to chance. …