The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis

Abstract

Poor adherence remains a major barrier to achieving the clinical and public health benefits of antiretroviral drugs (ARVs). A systematic review and qualitative meta-synthesis was conduct to evaluate how ARV adverse drug reactions may influence ARV adherence. Thirty-nine articles were identified, and 33 reported that ARV adverse drug reactions decreased adherence and six studies found no influence. Visually noticeable adverse drug reactions and psychological adverse reactions were reported as more likely to cause non-adherence compared to other adverse drug reactions. Six studies reported a range of adverse reactions associated with EFV-containing regimens contributing to decreased adherence. Informing HIV-infected individuals about ARV adverse drug reactions prior to initiation, counselling about coping mechanisms, and experiencing the effectiveness of ARVs on wellbeing may improve ARV adherence.

The right combination – treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in Johannesburg, South Africa

“…While adverse drug reactions (ADRs), treatment tolerability, clinic attendance, development of coinfections, concomitant treatments, and treatment/pill fatigue have been identified as barriers to adherence, cumulative time on treatment has also been associated with decreases in adherence levels. 5 , 6 , 9 , 24 – 26 It is at this time, later on in treatment, where a simplified, single-pill per day regimen may be more effective than a multi-pill regimen (each with varying dosing instructions serving to increase patient burden). Conversely, a FDC may be restrictive in its ability to form part of a holistic treatment plan which addresses coinfections.…”

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

“…Pinheiro et al 13 found that elderly patients had a higher adherence rate and, consequently, that a higher proportion of these patients had an undetectable viral load. Additionally, nonadherence has been correlated with use of illicit drugs, 14,15 smoking, 14,16 alcohol consumption, 16 depressive symptoms, 17 lower schooling levels and economic status, 8,15 adverse reactions, 18 symptoms of opportunistic diseases 8 and longer time between infection and receiving the diagnosis of HIV and starting treatment. 15 Interruption or irregularity of use of antiretroviral drugs is a public health problem in the fight against the HIV epidemic.…”

Anti-Retroviral Protease Inhibitors Regulate Human Papillomavirus 16 Infection of Primary Oral and Cervical Epithelium

“…HAART usage is associated with development of adverse oral complications, resulting from oral and perioral manifestations due to oral ulcerations, epithelial hyperplasia and xerostomia [24,25], that damage the mucosal epithelium and potentially expose the underlying tissues to infections due to multiple microorganisms, including HPV infections [24][25][26]. Damage-induced inflammation in the oral epithelium decrease patient adherence to drug regimens [51], that ultimately correlate with suboptimal drug levels and development of drug resistance that could compromise future therapy. Patients on HAART may develop painful oral lesions that affect chewing and swallowing, further contributing to development of malnutrition and weight loss, and also adds to the increased morbidity [52].…”