Resurrecting the 'fourth 90': towards a definition of health-related quality of life in HIV care

Pillars of long-term antiretroviral therapy success

BACKGROUND

Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies.

METHODS

With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care.

RESULTS

Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed.

CONCLUSIONS

Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.

Intentional non-adherence in the context of antiretroviral therapy

Adherence to antiretroviral therapy (ART) is a crucial determinant of treatment success in HIV. This article seeks to look closely at intentional non-adherence and why some patients choose to opt out of life-sustaining treatment. There is a range of reasons why patients intentionally stop taking their ART and the author take a more detailed look at some of those reasons, specifically religion, the need for control and social isolation. Case studies are included throughout the discussion to give more depth and increase understanding. The author goes to explore strategies that can be employed to help nurses in their response, as health professionals, to support patients and deliver high-quality and non-judgemental care.