HIV in Canada: A primer for service providers



Key Points

  • Effective treatment with HIV drugs requires long-term adherence.
  • Poor adherence can lead to resistance and drug treatment failure.

Antiretroviral therapy (ART) has helped to transform HIV into a chronic illness. However, adherence is important to see the benefits of HIV treatment. Adherence is taking HIV treatment everyday as prescribed.

Adherence is critical for the attainment and sustainment of an undetectable viral load. Non-adherence to ART can result in poorer treatment outcomes, including treatment failure, which can lead to greater morbidity (illnesses) and mortality (death). Furthermore, non-adherence can lead to drug resistance, which can reduce future treatment options.

Interventions to improve adherence to ART need to be individualized, multifaceted and repetitive. Frequently-used interventions include individualized dosing instructions with photos of the drugs, drug organizers (e.g., seven-day or even 28-day pill boxes), more frequent follow-up, and special adherence education sessions led by members of the care team (nurses, pharmacists, social workers, community health intermediaries or peer educators). In certain populations, such as people who use drugs, directly observed therapy (DOT) for ART has produced significant improvements in adherence and viral suppression.


Adherence and Resistance

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  1. Conway B, Prasad J, Reynolds R, et al. Nevirapine (NVP) and protease inhibitor (PI)–based regimens in a directly observed therapy (DOT) program for intravenous drug users (IDUs). In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 24–28, 2002. Abstract 545.
  2. Kensett S, McKillip B, Sauer J, et al. Maximally assisted therapy (MAT): an HIV care program to improve adherence to antiretroviral medications (ARVs) for residents of the Downtown Eastside (DTES) of Vancouver. In: Abstracts of the 13th Annual CANAC Conference, Banff, Alberta, April 30 – May 30, 2005.
  3. Mitty JA, Stone VE, Sands M, et al. Directly observed therapy for the treatment of people with human immunodeficiency virus infection: a work in progress. Clinical Infectious Diseases. 2002;34:984–990.
  4. Mitty JA, Macalino GE, McKenzie M, et al. Directly observed therapy (DOT) among HIV-seropositive substance users: a pilot study. In: Program and abstracts of the 39th Annual Meeting of the Infectious Diseases Society of America, October 25–28, 2001, San Francisco, California. Abstract 707.
  5. Shuter J. Forgiveness of non-adherence to HIV-1 antiretroviral therapy. Journal of Antimicrobial Chemotherapy. 2008;61(4):769–773.
  6. Stone VE, Adelson-Mitty J, Arnsten JH, et al. What strategies do providers use to enhance adherence to HAART? In: Abstracts of the XIII International AIDS Conference, July 9–14, 2000, Durban, South Africa. Abstract ThPeB5027.
  7. Turner BJ. Adherence to antiretroviral therapy by HIV-infected patients. Journal of Infectious Diseases. 2002;185(Suppl 2):S143–S151.
  8. Wood E, Hogg RS, Yip B, et al. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 x 109 cells/L. Annals of Internal Medicine. 2003;139(10):810–816.
  9. World Health Organization (WHO). The world health report 2004 —changing history. Geneva: WHO; 2004. Available from:

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