Today, people living with HIV, thanks to advances in research and new therapies, have a much higher life expectancy and quality of life than in the past. However, advancing age often exposes them to the comorbidities that other age-related diseases can cause, with the consequent need to follow therapies for other chronic diseases as well. This aspect can influence adherence to antiretroviral therapy, especially oral therapy, which requires consistency and regularity on the part of the patient. Adherence, in fact, can be tiring for those who have to take a therapy throughout their life, especially on a daily basis.
Oral therapy: the simplest possible, always talking to the patient
“In patients who have comorbidities or who for other reasons are undergoing polytherapy, that is, who are already taking an oral therapy consisting of several tablets, the antiretroviral therapy must be as simple as possible, because among other things the pill for the therapy for HIV infection sometimes has a “different flavour” for the patient, in a metaphorical sense of course, because it is associated with a psychological burden”. He explains Antonella Castagnadirector of the Infectious Diseases Clinic at the Vita-Salute San Raffaele University, San Raffaele Scientific Institute in Milan.
“It is important to find strategies that remind the person as little as possible that they are HIV positive,” he observes. Gabriella of Hectorassociate professor of Infectious Diseases at Sapienza University of Rome, who continues: “but another aspect that contributes to helping adherence to therapy is explaining to the person living with HIV what we are going to do together. Managing the infection means taking a therapy that keeps the virus under control and only when we doctors inform the person of what the task of the therapy is and what they can face if they don’t take it, then a doctor-patient alliance is established that becomes a therapeutic alliance that contributes to optimizing adherence to therapy”.
“You have to know the patient and, beyond the progress of therapies, the relationship between doctor and patient is essential for the success of the treatment”, he underlines Elio Manzillodirector of the UOC Immunodeficiencies and Immigration Diseases, Azienda Ospedaliera Specialistica dei Colli, Ospedale Cotugno in Naples. “The therapeutic path is not a mere distribution of drugs or convincing the patient that the drug he is being administered is the best – he continues – the patient must be led by the hand and followed”.
“Sometimes we think of therapeutic adherence as a set of factors that are very difficult to manage – and this is partly true even if today’s antiretroviral therapies have greatly simplified the task for us – but I would say that listening to the patient and a personalized approach are fundamental. And we probably still have a bit of progress to make on this aspect”, Castagna underlines.
Each patient has his own solution and the practicality of the packaging counts
“The key message – specifies D’Ettorre – is that each person is unique, is different from the other, there is no therapy suitable for everyone, there is the therapy that must fit well to the individual person”.
In this perspective, especially with regard to oral therapy, even small attentions, such as compact and discreet packaging and, thanks to the indication of the days of the week, which helps to keep track of the pills, can be important to promote adherence to the therapy.
“Absolutely, among other things we have direct experience of this when we conduct clinical studies where there is a much more stringent verification of the number of pills delivered to the patient and returned; therefore, everything that seems like small details, but which favor the assumption of the therapy in a simple way, also has an impact on adherence to the therapy and, in general, on the quality of life”, argues Castagna.
“We often forget that having to carry pills with you and perhaps need to store them in a certain way may not always be easy for the individual person, depending on their life. So even the packaging of drugs becomes an important aspect that companies, I must say, take into consideration not only for reasons of storage and transport but also to help patients not to forget to take the drug. This is an important aspect because we are dealing with a chronic infection and precisely this chronicity of taking drugs can then be the cause of forgetfulness in everyday life”, adds D’Ettorre.
It is therefore easy to understand how even packaging that meets the patient’s needs for flexibility plays a significant role in the difficult psychological balance that optimal therapeutic adherence requires.
Moreover, people living with HIV are aware of having more therapeutic options available, but this also exposes them to the risk of lower adherence: “Being aware of having more effective and less toxic therapeutic opportunities available often causes a decrease in the level of patient adherence. In fact, compared to patients in the past, today’s patients start out in better conditions – Manzillo explains -. The people we observe as naive (those who have never taken a certain molecule, ed.) have a basic immunological situation that is certainly discrete, which allows them to respond better to pharmacological therapy but which should not lead them to lower their guard”, concludes Manzillo.
#HIV #experts #Dialogue #personalization #attention #practical #aspects #essential #therapeutic #adherence
