Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden

Abstract

Background: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos.

Methods: Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured  questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill >5.

Results: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count >500 cells/ml (215; 72.6%). Pill burden >5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose  combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidence
interval = 0.03–1.66, P < 0.00).

Conclusion: Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major  antiretroviral therapy‑related problems reported in this study.

Keywords: Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquired
immunodeficiency syndrome, pill burden