Many alcohol dependent HIV patients need assistance adhering to medications

Supervised medication delivery or simplified dosing regimens may be needed to ensure that HIV-infected patients with a history of alcohol problems stick to their medication regimens, according to a new study by researchers at Boston University Medical Center.

The research, which appears in the February 2005 issue of Antiviral Therapy, found that a multicomponent, individualized intervention, which includes addressing a patient’s alcohol use and providing HIV medication counseling as well as a medication timer device to facilitate pill taking, failed to change medication adherence in HIV-infected individuals with alcohol problems.

“Alcohol abuse has been associated with poorer medication adherence in HIV-infected individuals and heavy drinking is associated with taking antiretroviral therapy off schedule,” said Jeffrey Samet, MD, lead author of the study and professor of medicine at Boston University School of Medicine. “Our findings show that despite utilizing a defined and repeated intensive patient intervention, HIV-infected patients with alcohol problems did not improve adherence with their HIV medications.”

Researchers studied 151 HIV-infected patients with a history of alcohol problems on antiretroviral therapy. For three months, each patient participated in a clinical intervention with four distinct components: assessment and discussion of the patient’s alcohol and other substance abuse, use of a watch that served as a medication timer device, enhancement of perceived efficacy of medications, and a series of individualized HIV medication counseling sessions.

According to Samet, at follow-up, researchers found no significant differences in medication adherence, immune system suppression, HIV virus levels or alcohol consumption among the patients.

“It remains unclear what it will take to improve medication adherence among this challenging population,” explained Samet, chief of General Internal Medicine at Boston Medical Center (BMC). “Future efforts should focus on more systematic interventions, such as supervised medication administration or simplified dosing regimens. Even addressing an individual’s needs to improve pill taking for HIV/AIDS may not be enough to change behavior and ensure that the patient stick to his or her medication regimen.”