Guidelines: Improving Retention & Treatment Adherence in HIV

Patient adherence to antiretroviral therapy (ART) is one of the most impor­tant factors associated with successful HIV outcomes. Following a diagnosis, timely entry into HIV medical care is essential to the provision of ART. However, of the approxi­mately 1.2 million people in the United States with HIV, only 69% are linked to care. For those who start care, only about 59% are retained in care. Among people with HIV who are on ART, just 28% have undetectable viral loads, which indicate high adherence to therapy. The varied and complex evidence base resulting from more than 20 years of research in these areas had until recently not been fully evaluated. In an effort to improve entry and retention in care as well as ART adherence in patients with HIV, a guidelines committee sponsored by the International Association of Physicians in AIDS Care and the NIH Office of AIDS Research published evidence-based guidelines in the Annals of Internal Medicine. Click here to view the full guidelines. Key Recommendations Melanie A. Thompson, MD, who was the lead author of the guideline document, says that the recommenda­tions set a high bar for meeting the standard of evidence. “We systematically reviewed literature from domestic and international studies that have been published since 1996,” she says. After reviewing 325 randomized controlled trials and observational studies that met stringent criteria for high-quality, comparative evidence, the expert panel arrived at 37 recommendations to assist clinicians in their care of people with HIV, several of which are particularly notable (Table 1). “All patients should receive some form of one-on-one ART education and adherence support.” According to Dr. Thompson,...