An ongoing dialogue on HIV/AIDS, infectious diseases,
October 29th, 2011
Will An Antiretroviral Patch Help Adherence? Doubtful …
This little nugget came up recently, found by our Journal Watch Executive Editor:
Preliminary research suggests that a patch could deliver an AIDS drug to patients … The researchers successfully used transdermal patches to administer 96 percent of an AIDS drug to simulated skin over a week. “Still, the important limitation of pills, regardless of how few there are or even how minimal the side effects, is adherence,” Johnston [the investigator] noted. Research has shown that many patients, if not most, don’t take their pills all the time.
Setting aside for a moment the fact that most patients actually do take their medications just fine, thank you — and that this particular transdermal HIV drug delivery system hasn’t even been tested on animals, let alone humans — I have always wondered about the assumption that novel drug delivery systems would improve adherence.
Seems to me that the major problem with non-adherent patients isn’t that they can’t take pills.
It’s that they won’t take them.
And I strongly suspect that most would make the same choice when it comes to putting on a patch every day (or even every week).
2 Responses to “Will An Antiretroviral Patch Help Adherence? Doubtful …”
Paul E. Sax, MD
Associate Editor
NEJM Clinician
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Perhaps most patients in that Baltimore, MD study take their medications just fine… what about those at high risk for nonadherence? Putting on a patch once a week (perhaps supervised during a home visit by a health worker) could be a real improvement over twice-daily pills for some PLH whom I have encountered in a developing country setting. It could certainly be easier for those with a variable sleep or work schedule. I think it would be a simpler option for me if I were on ART.
Hi Amy,
Agree it might be handy … for those who agree to do it!
I also think that Baltimore study is pretty representative of a very challenging group of patients — here’s my review of it:
http://cid.oxfordjournals.org/content/53/6/605.full
My rough estimate is that around 10-20% of HIV patients don’t take their meds, but they loom very large in our minds since we spend so much time agonizing over them!
Paul