Major controversies in the DHHS guidelines for use of antiretroviral agents in HIV-infected adults. Department of Health and Human Services.

The NIH Office of AIDS Research and other organizations sponsored a 1997 conference promoting awareness of problems of adherence to multiple drug HIV therapy. Studies demonstrate that predicting a patient's adherence is problematic. Adherence behavior appears best determined through direct, nonthreatening patient questioning that is accepting rather than critical and understanding rather than judgmental. Patient self-reported adherence can be over-reported, so questioning should be deliberately loaded to elicit greater honesty in the patient's response. Responding to adherence problems is the joint responsibility of the patient, the provider, and the system of care that involves tailoring drug regimens to lifestyle, conducting adequate patient education, and providing a patient feedback system. Managed care cost cutting realities, however, make the entire adherence process more daunting. Finally, because the demographics of HIV/AIDS are shifting toward more marginalized populations with tenuous relationships to the health care system, creative new approaches and resources are needed to provide access to care, deliver highly active antiretroviral therapy, and assure adherence.