Adherence to Antiretroviral Therapy: Merging the Clinical and Social Course of AIDS

1217 The survival of people diagnosed with HIV/AIDS dramatically improves with access to highly active antiretroviral therapy (HAART). Such therapy employs a combination of antiretroviral agents—protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleotide reverse transcriptase inhibitors, and fusion inhibitors—to suppress viral replication, and, thus, reduces the likelihood of developing HIV mutations that could lead to the development of drug-resistant viral strains. HAART also prevents further viral destruction of the cellular immune system, thereby, allowing for increases in the level of CD4+ cells, which improves the immunologic response to opportunistic infections. However, suboptimal treatment adherence has been associated with virologic, immunologic, and clinical failure. In this essay, I look critically at the issue of adherence, and argue that, to address causes of incomplete adherence, we need to combine both quantitative and qualitative methodologies. These methodologies must be grounded in an understanding of adherence as a biological and social process that changes with time, and must be framed within an analysis of access to health care and medications.