Reasons for non-adherence to antiretroviral therapy: patients' perspectives provide evidence of multiple causes

The objective of the study was to define common reasons for non-adherence ( NA) to highly active antiretroviral therapy (HAART) and the number of reaso ns reported by non-adherent individuals. A confidential questionnaire was a dministered to HIV-seropositive patients taking proteinase inhibitor based HAART. Median self-reported adherence was 95% (n = 178, range = 60-100%). T he most frequent reasons for at least 'sometimes' missing a dose were eatin g a meal at the wrong time (38.2%), oversleeping (36.3%), forgetting (35.0% ) and being in a social situation (30.5%). The mean number of reasons occur ring at least 'sometimes' was 3.2; 20% of patients gave six or more reasons ; those reporting the lowest adherence reported a significantly greater num bers of reasons (rho = -0.59; p < 0.001). Three factors were derived from t he data by principal component analysis reflecting 'negative experiences of HAART', 'having a low priority for taking medication' and 'unintentionally missing doses', accounting for 53.8% of the variance. On multivariate anal ysis only the latter two factors were significantly related to NA (odds rat ios 0.845 and 0.849, respectively). There was a wide spectrum of reasons fo r NA in our population. The number of reasons in an individual increased as adherence became less. A variety of modalities individualized for each pat ient are required to support patients with the lowest adherence.