HIV treatment adherence

As of 2020, a total of 46,931 individuals are receiving treatment for Human Immunodeficiency Virus (HIV) infections throughout Malaysia and a total of 3,146 new cases were reported in the same year.

HIV is a virus that attacks and destroys human immune system. This virus can be transmitted through body fluids which include blood, semen, vaginal fluid and breast milk.

Contrary to popular myth, individuals will not get HIV infection through normal contact such as kissing, sharing drinks or shaking hands.

Certain behaviours and conditions may put individuals at greater risk of contracting HIV. This infection can spread through unprotected sexual intercourse, illicit injection drug use or needle sharing, unsafe blood transfusion, needle stick injury or from mother to child during pregnancy, childbirth and breastfeeding.

To date, there is no effective cure which means that once a person is infected with HIV, they will have it for life.

However, appropriate medical treatment and regular screening can extend the life of people living with HIV (PLWH) and prevent HIV from spreading.

On the other hand, if HIV infection is left untreated, it can progress to Acquired Immunodeficiency Syndrome (AIDS), the serious stage of HIV.

In AIDS patient, the virus has severely damaged one’s immune system making patients susceptible to opportunistic infections that happened more frequently and more severe in people with weakened immune system.

Highly Active Antiretroviral Therapy (HAART)

The treatment used for HIV infection is commonly known as Highly Active Antiretroviral Therapy (HAART).

It prevents deoxyribonucleic acid (DNA) of the virus from replicating hence, reducing the number of viruses in the body to undetectable levels and provide a better quality of life for PLWH.

HAART comprises three or more antiretroviral medications from at least 2 different classes. This combination is required to successfully suppress the HIV replication, reduce the risk of medications resistance and ensure the effectiveness of the therapy.

Before commencing the treatment, health care providers need to evaluate the willingness and readiness of patients to initiate HAART.

Counselling from doctors and pharmacists trained in HIV treatment is needed to ensure that patients understand the importance of compliance.

PLWH should also be informed that the first HAART regimen offers the best opportunity for effective viral suppression and immune recovery. Non-compliance with medications may lead to treatment failure.

These are the categories of HAART medicines available in government health facilities in Malaysia:

• Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) - Nevirapine, efavirenz
• Nucleoside Reverse Transcriptase Inhibitor (NRTI) - Abacavir, lamivudine, tenofovir, emtricitabine, zidovudine, stavudine, didanosine
• Integrase Inhibitor (INI) - Raltegravir, dolutegravir
• Protease Inhibitor (PI) - Atazanavir, ritonavir, lopinavir

HAART are categorised according to their mechanism of action.

The variety of HAART combinations allows the doctors to choose regimen according to patients’ needs and suitability.

The use of medications that inhibit the production of HIV virus at different stages can increase the success of HIV treatment and reduce the risk of resistance.

However, despite the use of HAART combination, resistance can still happen if patients are non-compliant. Since HAART regimens commonly involve taking multiple medications at the same time, Fixed-Dose Combinations (FDC) product that contains multiple active ingredients in one tablet can facilitate patient’s medication adherence hence, overcoming resistance issue.

Taking your HIV Medication Correctly

For optimum efficacy, it is imperative for patients to take HIV medications every day as prescribed by the doctor. The drug-food interactions may vary depending on the medication.

For instance, tenofovir should be taken on an empty stomach as food can slow down its absorption while ritonavir should be taken after meal to reduce its side effects.

Other than that, patient is encouraged to develop an individualised medication schedule that links to patient’s lifestyle. Phone alarm may also help patients with their compliance.

Discuss with your doctors or pharmacists if you have any concern.

Side Effects

Side effects of HAART may vary depending of the medications and individual reaction.

The most commonly reported side effects are dizziness, nausea, vomiting, depression, anxiety, nightmares and insomnia.

Patient would normally experience side effects for the first few weeks which will gradually go away after your body adjust to the medications.

There are also side effects that can only be known by performing blood tests such as changes in liver and kidney function. It is essential for patients to attend follow up appointment so that the doctors can evaluate the effectiveness of the treatment and detect any unwanted side effects.

Side effects of HAART are a major reason for discontinuation of therapy and poor adherence towards HAART. Please notify doctors and pharmacists if patient has problems or concerns that may affect medication compliance.

Conclusion

HIV infection is not the end of life.

Adherence is hard work and takes a lot of commitment.

Lapses in treatment adherence can happen to anyone.

It is important that members of the healthcare team establish rapport with the patients to achieve maximal viral suppression and improve patient’s quality of life.

Any further inquiries about medications can be made to the National Pharmacy Call Centre at 1800-88-6722, every Monday to Friday, 8am to 5pm (except public holidays).

Chong Jeng Lin is a UF 44 pharmacy officer at Hospital Sultan Abdul Halim, Sungai Petani, Kedah.