Adherence to anti-retroviral drugs.

Sir,

The article on adherence of people living with HIV to anti-retroviral therapy (ART) is well-timed and deserves credit for pointing out certain delicate issues1. However, consideration of a few points would have strengthened the study.

It is not clear why education, gender, employment status and socio-economic status were not considered for regression. Previous studies from India have found evidences that these factors influence adherence to ART in our set up where drug is provided free of cost but attending ART centres once a month may not be possible for patients challenged with sickness and economic instability234. Authors have mentioned stock-out of ART as one of the reasons for poor adherence. From programmatic point of view, it was important to know the extent of the problem as free availability of ART is a major recognized reason for adherence4. In addition, it is difficult to draw any conclusion from the relationship between duration of ART and poor adherence. Those who are new to ART, adherence may be an issue due to side effects. It improves when they are getting habituated (>7 months duration), as evident from the study. However, the reason for drop in adherence once they complete one year of treatment, is not clear. It might be simply due to sub-optimal grouping of patients, based on duration of ART. A study from Bengaluru has reported that the new patients (on ART for less than 6 months) or those who are taking drugs for more than 10 years are more likely to miss medication5. Similarly, in the present study, regrouping of patients with a longer interval (e.g. <1 year, 1-3 years or so) would have yielded meaningful conclusion about effect of duration of ART on adherence. In brief, further analysis is warranted in patients taking ART for more than one year.