Beyond HIV: Understanding and Improving Medication Adherence for Co-Existing Conditions
"New research reveals how HIV patients perceive their medications for other conditions differently than their HIV treatments, impacting adherence. What can be done?"
Thanks to advancements in treatment, people living with HIV are living longer, healthier lives. However, this also means managing other chronic health conditions that can arise with age, like heart disease, osteoporosis, and depression. This often requires taking multiple medications, creating a complex regimen that can be difficult to stick to.
A recent study explored how HIV-positive individuals perceive their medications for these co-existing conditions compared to their antiretroviral therapy (cART). The findings reveal significant differences in beliefs and adherence, highlighting areas where healthcare providers can improve patient support and education.
This article will break down the study's key findings and offer practical insights for both patients and healthcare professionals looking to optimize medication adherence and overall well-being in the context of HIV and co-existing conditions.
Comorbidity and Medication Burden
People living with HIV have greater comorbidity and comedication burdens than people without HIV, according to findings from a contemporary U.S. cohort covering 2020–2024. These burdens matter when selecting antiretroviral therapy (ART), since clinicians are advised to consider potential drug interactions and adverse events. A systematic review of HIV treatment regimens also notes that real-world studies often find poor long-term adherence, while adherence may be higher in randomized controlled trials because of participant selection and other trial conditions.
The HIV Care Continuum
NIH describes HIV treatment adherence as part of a continuum that includes linkage to care after testing, starting ART, staying engaged in appointments, and taking treatment as prescribed. The guidance recommends a multidisciplinary approach involving, as available, nursing, pharmacy, social work, and case management to identify and address barriers to medication and appointment adherence. Linkage can be affected by insufficient socioeconomic resources, and the NIH emphasizes that these efforts should be delivered with compassion and persistence. A 2023 paper also identifies adherence barriers as an ongoing challenge and examines them from the perspectives of people living with HIV and health and social-service professionals.
Adherence Across HIV Treatment’s Evolution
A 2018 Nature milestone timeline charts HIV research from the epidemic’s origins through developments in treatment, vaccines, and insights into HIV/AIDS. More recent treatment advances have expanded adherence options: a review describes cabotegravir and rilpivirine injections given every two months and lenacapavir given every six months as showing promising efficacy for a subset of patients, including use outside approved indications. U.S. research on medication adherence has also reported that the quality of routine adherence care at clinical sites significantly affects medication-taking behavior, and that increased attention to adherence may help explain improvements in treatment implementation.
The Belief Gap: How Patients See HIV Meds vs. Other Treatments
The study, published in HIV Medicine, involved 105 HIV-positive patients in Switzerland who were also taking medication for other chronic conditions. Researchers used questionnaires to assess patients' beliefs about their HIV medications (cART) and their other medications (co-treatments).
- Necessity: Patients felt their HIV medications were more necessary for their health than their co-treatments. The standardized mean responses for the BMQ Specific-Necessity subscores were 4.46 [standard deviation (SD): 0.58] and 2.86 (SD: 1.02) for cART and co-treatments, respectively (P < 0.0001).
- Concerns: Patients had greater concerns about potential side effects and negative consequences associated with their co-treatments compared to their HIV medications. For Specific-Concerns, the standardized mean responses were 2.9 (SD: 1.02) for CART and 4.09 (SD: 1.02) (P < 0.0001) for co-treatments.
- Adherence: A higher percentage of patients reported being adherent to their HIV medications compared to their co-treatments. Eighty-seven patients (83%) were adherent to cART and 75 (71%) were adherent to their co-treatments (P = 0.0001).
Medication Review in Aging With HIV
A review on polypharmacy, drug–drug interactions, and inappropriate drugs in the aging population with HIV describes a medication-reporting process used in the Swiss HIV Cohort Study (SHCS). Participants were contacted by post one week before their twice-yearly SHCS appointment and invited to list all current medications, their dosages, and the date and time of their last dose on a dedicated form. They were asked to bring the completed form to their routine visit, creating a structured opportunity to document medication use.
Limits of Self-Reported Co-Treatment Adherence
A study of people living with HIV compared beliefs about chronic co-treatments with beliefs about combined antiretroviral therapy. Because participants could have several co-treatments, the researchers said it was not feasible to ask them to complete a separate questionnaire for every medication; instead, they assessed self-reported adherence to the co-treatment with the worst adherence. The study’s authors call for research with a larger sample and more objective adherence measures to explore the relationship between adherence and patients’ perceptions.
Regimen Complexity and Adherence Strategies
A 2019 systematic review examined whether single-tablet regimens (STRs), compared with multiple-tablet regimens (MTRs), are related to adherence and viral suppression; its source summary notes that suboptimal adherence is associated with regimen complexity and high tablet burden. A separate review of U.S. studies published between 2017 and 2020 examined adherence and pill burden, resistance burden, and comorbidities among people living with HIV. More recently, a 2026 report says scalable interventions—particularly reminders, counselling, and supporter-based approaches—improved adherence, while recommending that interventions be tailored to population needs.
Bridging the Gap: Improving Adherence for All Medications
The study highlights the need for healthcare providers to address the "belief gap" and provide better support for patients managing multiple medications. Here are some potential strategies:
Personalized and Long-Acting Treatment
A report on findings presented at AIDS 2026 says two-drug HIV regimens and long-acting injectable therapies offer effective treatment options and may support more individualized care. It highlights shared decision-making, adherence, quality of life, and reducing long-term medication exposure alongside viral suppression. The NIH strategic plan notes that more than half of people living with HIV in the United States are over age 50 and face challenges related to HIV’s long-term effects and its treatment across organ systems. Research on oral ART adherence interventions also points to adherence counselling beyond ART education as an effective approach.
Persistent Barriers in HIV Care
A review of HIV treatment and care identifies medication adherence, drug resistance, and access to healthcare as persistent challenges that hinder efforts to control the epidemic. An interview summary on long-acting ART describes these therapies as a potential way to address ongoing management challenges, with possible benefits including improved adherence, quality of life, and reduced impact of stigma. The summary frames long-acting treatment as an evolving part of HIV care rather than a resolution of all barriers.
<ul> <li>Education: Clearly explain the importance of all prescribed medications, not just HIV treatments. Address patient concerns about side effects and potential interactions.</li> <li>Communication: Encourage open communication between patients and providers about adherence challenges and any difficulties experienced with co-treatments.</li> <li>Individualized Approach: Tailor medication regimens and support strategies to meet the specific needs and beliefs of each patient.</li> <li>Simplify Regimens: Explore opportunities to simplify medication schedules and reduce the overall pill burden whenever possible.</li> </ul>
By understanding and addressing the factors that influence patient beliefs about their medications, healthcare providers can help improve adherence, optimize treatment outcomes, and enhance the overall quality of life for people living with HIV and other chronic conditions.