Chronic Disease

Worries about finances often prompt patients with HIV disease to skimp on their antiretroviral medication

Patients with HIV disease who are worried about their finances are more likely to be noncompliant with antiretroviral therapy (ART) prescriptions, according to a new study. This increases their risk of HIV drug resistance and lessens the ability of ART to slow the progression of their disease. Thus, questions about a patient's concern about financial matters such as paying bills or having enough money to care for themselves with HIV disease may help to identify patients who aren't taking their full dose of ART, suggest the University of Pennsylvania School of Medicine authors.

The researchers studied HIV-infected outpatients taking efavirenz plus two or three nucleoside analogue reverse transcriptase inhibitors and with HIV viral loads of less than 75 copies/mL (undetectable blood levels) for 1 year or until they had detectable HIV loads (signaling disease progression). They looked at high adherence (taking 95 percent of doses or more) versus low adherence (less than 95 percent) for 90 days prior to the onset of detectable HIV loads in the patient's blood.

Nearly half (48 percent) of the 116 recruited participants had low adherence. Baseline financial worries were greater in those with low versus high adherence, and were the only quality of life factor associated with medication adherence over time. Also, those with low versus high adherence were more likely to use alcohol and other drugs both at study enrollment and currently. Financial worries increased the odds of nonadherence 16 percent and alcohol use increased the odds nearly threefold. The study was supported in part by the Agency for Healthcare Research and Quality (HS10399).

More details are in "HIV/AIDS-specific quality of life and adherence to antiretroviral therapy over time," by William C. Holmes, M.D., M.S.C.E., Warren B. Bilker, Ph.D., Hao Wang, M.S., and others in the November 1, 2007, Journal of Acquired Immune Deficiency Syndrome 46(3), pp. 323-327.

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