Abstract
TO THE EDITOR: We commend Dr. Escobar and his colleagues for their study on the factors affecting patient adherence to highly active antiretroviral therapy (HAART). 1 Adherence is a relevant and prominent issue when dealing with the HAART in HIV-infected patients. Examining the factors influencing adherence provides clinicians a better idea as to how to assist patients in maintaining medication adherence.
However, we would like to make some comments that may help clinicians further enhance drug therapy in HIV-infected patients. When noticing that the sample population was taken from Madrid, Spain, the reader may wonder whether the results are applicable across the globe. The authors hint at the idea that factors such as race show inconsistent results in influencing adherence. We were particularly interested in this comment since, with Houston being a diverse city, race may play a major role in drug therapy decisions. Furthermore, Houston has a higher proportion of Hispanics, and efforts are currently underway to educate this growing population on AIDS. Nevertheless, it would have been better to address the issue directly or mention the point somewhere within the text or the limitations section.
The authors suggest that interventions by clinicians will help improve adherence, but steps in doing so are not addressed. Providing examples of interventions and roles that pharmacists can play would be helpful. For instance, education and counseling could be such interventions taken by pharmacists in helping patients understand the importance of adherence. 2 Hispanics comprise 13% of the US population, but account for 20% of those living with AIDS. 3 With the growing number of Hispanics who comprise US AIDS cases, the importance of increasing education about HIV and AIDS among this population rises. In Houston, the Latino HIV Task Force helps provide HIV and AIDS prevention programs and educational campaigns. Active participation by pharmacists in these task forces can contribute greatly to educational efforts. With the main authors of the article being clinical pharmacists, addressing the roles of pharmacists should have been discussed appropriately in this article. The reporting of factors affecting adherence in HIV-infected individuals is important, but attempts in providing interventional solutions would have strengthened the article further.
In addition, nonadherence increased 2.18-fold in HIV-infected patients with alcohol and/or drug abuse. Clarification and explanation of drug misuse, whether it be of illicit, prescription, or over-the-counter (OTC) drugs, would have helped in the implementation of certain results of this study to specific issues. Currently, the assessment of OTC drug use and misuse in HIV-infected patients has not been evaluated. We are designing a pilot study to understand the involvement of HIV-infected patients in self-medication practices, especially herbal preparations. The study will look at how self-medication practices affect drug therapy adherence and/or drug use/misuse, as well as adverse events and health-related quality of life. Evaluating these issues may further assist with adherence solutions for optimizing drug therapy in HIV-infected patients.2,3.