EDITORIAL

      273Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine

Adherence to Highly Active Antiretroviral Therapy (HAART) 
in HIV/AIDS Patient

Erni J. Nelwan
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, 
Jakarta, Indonesia.

Correspondence mail:
Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine 
Universitas Indonesia - Cipto Mangunkusumo Hospital. Jl. Diponegoro no. 71, Jakarta 10430, Indonesia.  
email: ejnelwan@yahoo.com.

HIV infection has been considered as a 
chronic illness since the availability of highly 
active anti retroviral treatments (HAART). The 
introduction of HAART to HIV/AIDS patient 
improve quality of life, life expectancy, decrease 
rate of resistance and further decrease mortality 
to AIDS related causes. Many studies showed 
the evidence of HAART efficacy to suppress 
viral replication among patient with continuum 
adherence to treatment. However, unlike other 
chronic medications which were only needed 
at least 70% adherence; success virological 
suppression rate in HIV/AIDS in patient required 
as high as 95% or near perfect adherence; and 
this remains to be an important issue for patient 
on HAART.1

In term of treatment, a long-term follow up of 
patient’s adherence, i.e. daily medication intake 
monitoring for life, becomes a routine practice. 
However, no gold standard is established 
to measure patients’ adherence. Thus in the 
beginning of treatment, assessment on how 
patient would be ready to take medication, 
existing any limitations such as mental illness 
or active drug use, understanding of disease and 
regimen, social support and patient schedule, 
should be asses. Clinicians have to educate 
patient starting on HIV treatment for having 
very low missed doses, and this was based on 
evidence we have from a decades ago. By that 
time, treatment regimens were more complex. 
Lowering the threshold of adherence would not 
be possible because allowing for missed dose 

will only favor to poor compliance within time. 
Then, continuous support and intervention during 
treatment are needed to maintain high level of 
adherence to HAART intake.2

There has been significant progress made 
r e g a r d i n g  d e t e r m i n a n t s ,  m e a s u r e m e n t s , 
and interventions to improve adherence to 
antiretroviral therapies. Systematic review 
on factors related to adherence of treatment 
classified several factors contributed to failure 
on adherence included: (1) patient related factor 
such as mental illness or physical symptoms, 
(2) beliefs about the medications, (3) life long 
treatment and (4) interpersonal relationships.3 
All of these contributing factors should address 
equally in each patients.

Given the various assessment strategies and 
potential interventions available, the challenge 
for the treatment team is to select the techniques 
that provide the best fit for their treatment 
setting, resources, and patient population. The 
complexity of this topic and the importance of 
adherence encourage clinicians to continue to 
seek novel, patient-centered ways to prevent non-
adherence and to tailor adherence interventions. 
Early detection of non-adherence and prompt 
intervention can greatly reduce the development 
of viral resistance and the likelihood of virologic 
failure.4 On this edition, Surilena et al.5 have 
shown the influence of emotive behavior therapy 
to HAART adherence particularly in female 
patient.



Erni J. Nelwan                                                                                                                     Acta Med Indones-Indones J Intern Med

274

REFERENCES
1. Kobin A, Sheth N. Level of adherence required for 

virological suppression among newer antiretroviral 
medication. Ann Pharmacol. 2011;45(3):372-9.

2. Cote J, Godin G, Ramirez-Garcia P, et al. Virtual 
i n t e r v e n t i o n  t o  s u p p o r t  s e l f - m a n a g e m e n t  o f 
antiretroviral therapy among people living with HIV. 
J Med Int Res. 2015;17(1):e6.

3. Hart JE, Jeon CY, Ivers LC, et al. Effect of directly 
observed therapy for highly active antiretroviral 
therapy on virologic, immunologic, and adherence 
outcome: a meta analysis and systematic review. J 
Acquir Immune Defic Syndr. 2010;54(2):167-79.

4. The DHHS panel on antiretroviral guidelines for adults 
and adolescents. Guidelines for the use of antiretroviral 
agents in HIV-1-infected adults and adolescents. Dept. 
of Health & Human Serv. 2008;1-139. Available 
online on http://www.aidsinfo.nih.gov/contentfiles/
adultandadolescentGL.pdf.

5. Surilena, Ismail RI, Irwanto, et al. The effect of rational 
emotive behavior therapy (REBT) on antiretroviral 
therapeutic adherence and mental health in women 
infected with HIV/AIDS. Acta Med Indones-Indones 
J Intern Med. 2014;46(4):283-91.