Evaluation of adherence to antiretroviral therapy in adult HIV (+) patients

Objective: Today, with the introduction of highly effective antiretroviral treatments, the treatment of people living with HIV has become easier. When patients adhere optimally to combination antiretroviral treatments, HIV infection transforms from a potentially fatal condition to a manageable chronic disease. In case of poor compliance with antiretroviral therapy; Viral suppression is not at the targeted level, the desired treatment success cannot be achieved, and this puts the patient's health at risk. Poor adherence to treatment increases the risk of persistent treatment resistance to a particular agent or group of agents in a given combination therapy regimen. This may have negative effects on treatment costs and therapeutic options. To achieve viral suppression and optimize outcomes in HIV+ patients, it is important that all members of the healthcare team address potential barriers to adherence. Monitoring viral load in HIV patients is the gold standard for monitoring treatment compliance. However, an increase in viral load in the blood can be detected long after decreases in compliance with treatment. Another approach to monitoring adherence is adherence scales based on patient feedback. This study aimed to determine the compliance rates of HIV-positive patients with antiretroviral treatment, to determine the reasons why patients do not adhere to their treatment adequately, and to investigate the factors affecting their compliance. In addition, it was aimed to investigate the usability of the compliance scales in clinical practice by comparing them with each other and with HIV RNA and CD4+ levels. Materials and methods: 120 HIV-infected patients who were followed up in outpatient clinic conditions by Çukurova University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology were included in the study. Demographic data, CD4+ T lymphocyte counts, and HIV RNA levels of patients who met the study criteria were recorded. Individuals living with HIV who participated in the study were asked: Visual analogue scale (VAS), Morisky Medication Adherence Scale, single-item measurement during the last 3-month recall period, and "When did you last forget to take your HIV medication?" included in the Adult AIDS Clinical Research Group adherence survey. ' single-answer scale was applied. SPSS 25.0 package program was used in the statistical analysis of the data. In all tests, the statistical significance level was taken as 0.05. Results: The average age of the patients in the study was found to be 39.1±11.9 years, and 101 (84.2%) of the participants were male. The compliance rate of our patients according to VAS was found to be 80%, and a significant correlation was found between VAS and HIV RNA. VAS had a high rate of accurate prediction of viral load (p < 0.001). A significant relationship was observed between the adherence level rates we found with the Morisky medication adherence scale and VAS, but no correlation was found with HIV RNA. It was determined that the measurement question of the last time you forgot to take a medication was correlated with both VAS and HIV RNA. None of the ART adherence scales were significantly associated with CD4 counts. According to the VAS scale, the rate of using a single tablet regimen was found to be higher in the low-compliance patient group. The most common reasons for non-compliance were determined as 'I forgot to take medication, I was away from home - I did not have the medication with me and I ran out of pills'. The diagnostic performance of the VAS scale HIV RNA between the groups below 50 and over 50 was examined with the RocCurve test. The VAS cut-off value was determined as ≤80. It was determined that the patient had a positive viral load with a sensitivity of 69.23% and a specificity of 85.98%. Conclusion: In our study, the compliance rates of individuals living with HIV, factors affecting compliance, and reasons for non-compliance were found to be at similar levels to the data in the world. We think that the VAS scale can be used to monitor ART compliance in HIV+ patients. The Morisky medication compliance scale, which is widely used to monitor treatment compliance in chronic diseases, did not provide the expected benefit in the follow-up of HIV patients with the version we used in our study. In the measurement method that questions the time of forgetting to take medication last remembered, not having taken medication recently was found to be associated with non-compliance. Keywords: HIV/AIDS, ART Adherence, VAS