Accounts for non-adherence to antiviral combination therapies among older HIV-infected adults

While HIV-patient education has emphasized the importance of adherence to antiviral combination therapies, the complexity of current multi-drug regimens, coupled with aversive side-effects pose significant threats to adherence. Given that greater non-adherence among older adults is well documented in the general medication adherence literature, older HIV-infected adults may be at elevated risk for non-adherence. Patient accounts for non-adherence were explored as part of a psychosocial investigation of the experiences of HIV-infected late middle-age and older adults on protease inhibitors. Thematic classification of the 'accounts' offered for non-adherence according to Scott and Lyman's typology of justifications and excuses allowed for the identification of the perceived motives for intentional versus unintentional non-adherence. Excuses offered for non-adherence included: (1) intolerable side-effects, (2) unusually busy lives, (3) unavailability of food when needed, (4) tiredness, and (5) the need to conceal medications to avoid stigma/exposure of HIV status. Common justifications for non-adherence were: (1) some flexibility won't hurt me, (2) no one really knows the real impact of non-adherence, (3) if my viral load is 'undetectable' then strict adherence is not necessary, and (4) strict adherence is an unattainable standard. In contrast to expectations, few age-related reasons for non-adherence were identified. These understandings for their non-adherence provide a crucial basis for understanding new paths for promoting adherence to combination antiviral therapies.