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Issues with Treatment

As we’ve learned more about HIV and how to treat it, we’ve developed highly effective medications that have changed what it means to live with HIV. Life expectancy with HIV has increased significantly with the use of ART medicines (antiretroviral therapy). Some recent studies have suggested that for an individual with HIV who takes their ART as directed, life expectancy is approaching, or even the same as, the general population.1-3 This is especially true for more developed countries. However, anyone who is dedicated to treatment and maintains regular appointments with their healthcare team, regardless of their background, can increase their life expectancy with HIV.3

Those with HIV who are pursuing treatment and trying to reach an undetectable viral load (small amounts of virus in the blood that it is not detected on testing) often follow a common care continuum or pathway. This includes being diagnosed with HIV, being linked to and staying in professional care, taking ART and, finally, achieving viral suppression (an undetectable viral load).

Finding a healthcare provider and sticking with them long-term so that they can regularly monitor and adjust ART regimens is a critical step in finding success with treatment. Common issues that can impact this pathway and treatment success include adherence, drug resistance, and issues with access to care.

What is adherence?

The term adherence, or being described as someone who is adherent to their treatment regimen, refers to someone who is taking their medications exactly as prescribed. Individuals who are adherent to their medication regimen follow their healthcare provider’s instructions, take their medications when they are supposed to, and rarely miss doses of their medicine.

Why is adherence important to HIV treatment?

Regular and consistent treatment is important in controlling HIV for several reasons. Specifically, skipping doses or not taking HIV medications as prescribed can lead to a decreased amount of these medications in the bloodstream, allowing HIV to replicate and become more severe.

When HIV is untreated (or not treated properly) and allowed to multiply in the body, it attacks immune cells called CD4 cells (also called T cells). These cells play an important role in helping us fight off illnesses and foreign invaders. With few to no CD4 cells, the body can be vulnerable to life-threatening conditions such as cancers, fungal infections, other viral infections, and more. These illnesses can then lead to mortality.4-6

Resistance to HIV treatment options

Another reason why consistent treatment is important is to prevent the mutation of HIV as much as possible. When HIV replicates in the body as a result of no treatment or poor adherence to treatment, it has the potential to mutate or change itself.

When HIV mutates, certain medications may not fight the virus as effectively. If HIV continues to mutate, fewer and fewer treatment options may be effective against it, speeding up the progression of HIV.4,5 When treatment is taken as directed every day, the virus can be suppressed enough that mutations and treatment failures become rare. Treatment for HIV should be started as soon as possible after an HIV diagnosis is made.

Access to care

Access issues can be physical, emotional, mental, or financial, and can greatly impact an individual’s ability to get the care they need and deserve. Physical barriers to treatment or care include things like transportation issues or living in an area in which there isn’t a healthcare facility nearby (such as in a rural area). Mental and emotional barriers to care are also important and may include denial, fear, or feelings of low self-esteem or low self-worth (such as feeling as though an individual doesn’t deserve care).

How stigma impacts access to care

Additionally, and importantly, stigma can dramatically impact an individual’s desire or ability to seek and maintain care. Receiving and living with an HIV diagnosis often brings along with it real or perceived stigma, which can impact HIV-related health outcomes.

Several studies have found that perceived stigma in clinical settings has been linked to delays in treatment, poor follow-up care, worse adherence to medications, and less access to preventative measures such as HIV testing or condoms.7-10 All of these factors can lead to worse outcomes, making stigma an important aspect for both individuals with HIV and their healthcare providers to consider in order to increase access to care and improve long-term health.

HIV care, including treatments, testing, monitoring, and healthcare appointments can all add up financially and may be hard for some individuals to manage. Struggling to pay for care can present its own barriers to treatment, even when everything else is being managed well. Thankfully, entities like Medicare, Medicaid, the Ryan White HIV/AIDS Program, the Veterans Administration, pharmaceutical company-run financial assistance programs, and more are available for use and may be able to provide support. For more information on resources available to you, you can contact your state’s HIV/AIDS toll-free hotline.

Written by: Casey Hribar | Last reviewed: September 2019
  1. Rodger AJ, Lodwick R, Schechter M, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPIRIT trials compared with the general population. AIDS. 27 Mar 2013; 27(6), 973-979.
  2. The Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. The Lancet HIV. 1 Aug 2017; 4(8), PE349-E356. Available from: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext. Accessed July 30, 2019.
  3. Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: A meta-analysis. HIV Med. Apr 2017; 18(4), 256-266.
  4. Schaecher KL. The Importance of Treatment Adherence in HIV. Am J Manag Care. 2013; 19(12 suppl), S231-S237. Available from: https://www.ajmc.com/journals/supplement/2013/a472_sep13_hiv/a472_sep13_schaecher_s231. Accessed July 30, 2019.
  5. HIV Treatment: HIV Treatment Adherence. United States Department of Health and Human Services: AIDSinfo. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/54/hiv-treatment-adherence. Published February 18, 2019. Accessed July 30, 2019.
  6. AIDS-Defining Illnesses. United States Department of Veterans Affairs. https://www.hiv.va.gov/patient/diagnosis/OI-AIDS-defining-illnesses.asp. Published February 8, 2018. Accessed July 30, 2019.
  7. Giordano TP, Giffor AL, et al. Retention in care: A challenge to survival with HIV infection. Clinical Infectious Diseases. June 2007; 44(11), 1493-9. Available from: https://academic.oup.com/cid/article/44/11/1493/477758. Accessed July 30, 2019.
  8. Access Challenges for HIV Treatment: Among People Living with HIV and Key Populations in Middle-Income Countries. Policy Recommendations. Partnership of Global Network of People Living with HIV, Global Network of Sex Work Project, International Network of People Who Use Drugs, Global Forum on MSM and HIV, and International Treatment Preparedness Coalition. https://msmgf.org/wp-content/uploads/2015/09/Access_Challenges_for_HIV_treatment_KAPs.pdf. Published 2013. Accessed July 30, 2019.
  9. Kinsler JJ, Wong MD, et al. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care and STDs. 21 Aug 2007; 21(8), 584-92.
  10. Sayles JN, Wong MD, et al. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. Journal of General Internal Medicine. Oct 2009; 24, 1101-8. Available from: https://link.springer.com/article/10.1007/s11606-009-1068-8. Accessed July 30, 2019.