Barriers to HIV Treatment

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The HCPLive Peer Exchange: Optimizing Outcomes in HIV Treatment features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of Health Services at Ursinus College, also in Collegeville, PA.

The panelists are:

• Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
• Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
• Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

Also participating via video is Amir Qaseem, MD, Director of Clinical Policy for the American College of Physicians, based in Philadelphia, PA.

In this segment, the panelists discuss several barriers to treatment that can lead to poor outcomes in patients with HIV. In addition to treatment cost and individual patient preferences, Dr. Frank says “some of the greatest barriers are mental illness, substance abuse, and stigma.” He says patients who have any of those conditions “are more likely to not adhere to their regimens because of the complexity of the [treatment regimen] and their psychosocial issues.”

Frank also notes that sometimes people “feel guilty about having HIV infection.” They may live with people who are not aware that they have HIV. It can be "very hard for you to adhere to your regimen if you need to hide your pills, so that your family members are not aware that you have HIV medications in your cupboard,” says Frank.

Although illicit drug use can be a barrier to HIV treatment, Dr. Sax says that it “doesn’t so much alter the selection of the antiviral regimen as it does really raise red flags about the likelihood of the person persisting on it.” Many studies have shown that “active substance abuse, active alcoholism is a predictor of poor adherence to therapy,” Sax says.

However, Sax also notes that “once people are in recovery, often their adherence to HIV therapy is excellent. So we should not give up hope on these patients. When they’re in recovery they can do a super job of taking their medications.”