Why a patient might (inadvertently) forego receiving their HIV therapy

Lack of social or family support, guilt, substance abuse, chronic intolerance, and poor communication with medical staff... There are various reasons to stop using chronic medications like HIV medicine. Avoiding it is the goal in order to prevent the virus from reproducing and creating resistance.

Why a patient might (inadvertently) forego receiving their HIV therapy

HIV has become into a chronic illness. a condition that, in the vast majority of cases, can be effectively managed with medicine; this management makes the virus undetectable and thus stops it from spreading. In contrast to earlier times when HIV forced those who had it walk on a razor's edge, today's exceptional effectiveness of antiretroviral therapy makes it possible to live a life that is as normal as that of someone with hypertension, hypothyroidism, or high cholesterol. With the benefit that cutting back on salt or avoiding fats is not necessary.


However, sometimes things are not as straightforward. Any chronic illness can make it difficult to maintain medicine over time, but HIV patients have additional challenges that make treatment compliance challenging, which facilitates the development of resistance and jeopardizes the therapy's effectiveness. . These variables—like HIV—are intricate and take into account the patient's unique situation as well as their interactions with the medical staff or the properties of the medication.


The beginning is typically optimistic. After consulting with him at the Hospital Clinic of Barcelona, Dr. This is supported by José Luis Blanco, who says that since contemporary therapies are generally excellent, people typically take their medications carefully and encountering bad effects is relatively uncommon. tolerated”. Ferran Pujol, director of BCN Checkpoint, sees it similarly: "If we look at it globally, the level of adherence is very good, and the percentage of people with undetectable viral load is very high." BCN Checkpoint is a community center for the detection of HIV and other sexually transmitted infections aimed at gay men, men who have sex with men, and transsexual women in Barcelona.


This was made clear; in the future, the myriad circumstances that are creating the exceptions. Dr. Blanco believes there is a clear reason for treatment abandonment: "From my perspective, the most significant reason is that the patient finds it difficult to take the drug; it can be a simple guideline, but highly demanding." There are other strange interpretations, says Blanco: "There are several circumstances where the patient considers being a little more independent.


For instance, he may decide that it is preferable not to take it because the cold is passing, because he is taking antibiotics, because he is traveling, etc. He even uses the following example: "Today a youngster came who had opted to skip several takes' to prevent the toxicity of so many days...'." Because treatment non-adherence can happen at any moment, under any conditions, and with all kinds of patient profiles, even the most responsible, it is important to understand that it can happen to anyone.


This is further complicated by the fact that HIV carries a heavy social stigma that many people are unable to overcome. According to Pujol, "The burden of having to take medication for the rest of one's life is not only weariness with chronicity. Fear, guilt, stigma, marginalization, and a host of other factors are added in HIV, which can make taking the medication more difficult.


The key to preventing dropouts is identifying these conditioning elements. Chemsex, a practice of chemical use during sexual encounters that can extend for days, is one of the most frequent issues that causes poor adherence and, as a result, compromises the effectiveness of antiretroviral therapy.


Ferran Pujol expresses his concern over chemsex and "problematic substance intake" in general. In addition, despite all the issues with guilt and self-worth associated with HIV, there are those who are clinically undetectable but not emotionally. They feel guilty, and sadness is considerably more likely to set in for them.


In a similar vein, the director of BCN Checkpoint also refers to a "second closet" when he says, "Patients hide the medicines and hide the hospital appointments. These are obstacles to treatment adherence. As a result, it becomes risky to correctly continue taking the prescription when spending a few days at the family's home, walking the Camino de Santiago, or renting an apartment together. Ironically, the same routine that for some patients acts as a weight that transforms into a ball, for others acts as a support that keeps them anchored to their routines.


What might also occur to me?

The moment a patient asks, "How are my tests?", Dr. Blanco has a sneaking suspicion that something has gone wrong. He suspects that the patient may not have followed instructions to the letter and is now waiting to see if this is reflected in the analysis. "When you ask them, they may respond, 'I just went to a party; is that it?' The point is that it is simple for individuals to assume that nothing is happening and disregard shots if they observe that their levels are normal. And eventually, the virus develops resistance and becomes unforgiving.


The main focus of medical teams is on that. While it is true that most modern drugs generally have a permissive profile for dealing with amnesia, doctor White cautions that each person has a unique pharmacokinetic (the absorption, distribution, metabolism, and excretion of pharmaceuticals) profile. There is no exact science involved in this, and there is always a chance that they will quit taking their medications.


A virus that starts to reproduce again needs to be stopped from developing resistance, therefore medications need to be able to overcome sporadic failures of adherence.


Pharmacology uses a concept they call robustness to try and reduce this danger. It is not enough for medications to be effective in treating a patient's forgetfulness, carelessness, mistakes, or rebelliousness; they also need to be able to combat brief instances of non-adherence and stop a virus from starting to replicate again.


I didn't switch medications.

Current medications are predicted to be robust, as well as to simplify dosing recommendations and lessen side effects. In the past, HIV patients had to take numerous medications each day, endure their toxicity, and adhere to rigid dosing regimens.


Patients still follow these recommendations today: "They are the survivors. They have endured the most difficult period of living with HIV, and they generally put up with everything. "Without wanting to be paternalistic, I am amazed that there are people who have been living with HIV for 20 years and, when a change in treatment is suggested to them that is going to be beneficial for them, they tremble," says Pujol. "If their viral load is fine, they don't want you to switch them to another, more comfortable medication with fewer side effects."


Some of the most recently diagnosed patients may refuse to receive therapy if they believe it would result in an unintended disease when confronted with this "Virgencita, let me stay as I am" of long-term patients. According to Blanco, it is essential that people trust the medical staff and that they fully explain the issues to us. Because it's possible for individuals to stop taking the medication because it was incorrectly blamed for their symptoms or because they believe they must put up with what's happening to them. When an undesirable impact is observed, the medicine may need to be altered. But first, you need to establish a setting where people feel comfortable speaking up and we will pay attention.

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