In an article about antiretroviral therapy recently published in this journal Citation[1], the authors commented on the great benefits that the new combined therapy brought to patients, pointing out that the next challenge will be to make these medications available to all who need them.
Today, the Brazilian HIV/AIDS program is a world reference, mainly because all patients affected by the pandemic have access, guaranteed by law, to antiretroviral drugs, which are included in the national list of essential medicines.
Despite this, the greatest challenge facing the country today with regard to HIV/AIDS has been adherence to antiretroviral treatment. In studying this population, we found low adherence rates (between 50 and 75%), which is due mainly to patients' resistance to treatment because of the adverse reactions and complex therapies involved Citation[2,3].
In this letter, we would like to point out another possible cause of resistance based on one sentence that appears on the label of antiretroviral medicines, which means: ‘Caution: Improper use may cause AIDS virus resistance and treatment failure’. Such a sentence is a requirement of the Brazilian Ministry of Health Citation[4].
The importance of this information provided to the patient is unequivocal, and the intention of the authorities cannot be questioned. From our experience, however, we should emphasize that, paradoxically, its presence highlighted on the product label may reduce adherence to drug therapy. Often, we have heard from patients who report that they do not use the medication in the presence of people who do not know about their health problem. We have also observed patients who take the wrong medicine or inadequate dosage because they have removed the product's label.
From the patient's point of view, there is a big difference between using zidovudine, lamivudine and ritonavir, among others, and using a product that exposes a health condition that still is a taboo subject in our society. On the other hand, from a government policy viewpoint, and in view of the effective prevention and disease control, it seems important to examine whether the sentence is ruining the effort and is harmful to AIDS patients.
Further studies may contribute towards an understanding of whether the mentioned sentence is effective or harmful in this type of treatment. Until then, education campaigns to raise awareness about issues relating to rational use of medicines and viral resistance, especially among HIV/AIDS patients, could be considered a suitable alternative.
Declaration of interest
The authors state no conflict of interest and have received no payment in preparation of this manuscript.
Bibliography
- Domingo P, Vidal F. Combination antiretroviral therapy. Expert Opin Pharmacother 2011;12:995-8
- World Health Organization (WHO). Adherence to long-term therapies: evidence for action. Switzerland: Publications, 2003. Available from: http://www.who.int/chp/knowledge/publications/adherence_report/en [Last accessed 18 August 2011]
- Blatt CR, Citadin CB, Souza FG, Avaliacao da adesao aos antirretrovirais em um municipio do Sul do Brasil. Rev Soc Bras Med Trop 2009;42:131-6
- Brasil, Ministerio da Saude. Agencia Nacional de Vigilancia Sanitaria. Resolucao (RDC) n. 137 de 29 de maio de 2003. Brasilia, 2 June 2003. Available from: http://www.anvisa.gov.br/legis/resol/2003/rdc/137_03rdc.htm [Last accessed 18 August 2011]