Expectations and knowledge of medicines, often considered as drivers for compliance, have been shown in HIV-infected patients to be greater than other patient groups and yet compliance remains an issue.¹ To support this patient group with their complex medicine regime health care professionals (HCPs) require to gain a greater understanding of patients'concerns surrounding medicine taking.² This study explores patients' perceptions of and issues with antiretroviral therapy.

Method
Patients who attended an outpatient clinic at a regional infectious disease unit, identified by clinic staff as "appropriate", were considered for entry into the study. Of 50 patients approached, over a 2 week period, 21 consented (71% (15) male, 43% (9) homosexual, 33% (7) IV drug users) to participate in a semi-structured 1-to-1 interview in the clinic. All interviews were typed, transcribed verbatim, coded and grouped to form themes.

Results
Patients were mainly well informed about their therapy and perceived this as important, illustrated by one patient, "....well it's keeping me alive and healthy". The medicine regime was found to have variable impact on patients, from total interefernce, "...it's a pain really.....oh god, you know, it's like am I going to do this forever", to part of the daily routine, "...it's become second nature...it's like having a cup of tea". The issue of administration of medicines in relation to food was a common theme especially in a social context outwith the home environment, sometimes resulting in missed doses. Side-effects were frequently experienced, with patients often unsure if this was attributable of the disease or the medicines. Provision of medicine information on commencement of antiretroviral therapy was variable, several patients seeking information from support groups and the Internet. On being asked what was the worst thing about antiretroviral therapy most identified the complexity of the regime and their ideal as, a single tablet daily.

Discussion
This study illustrates that the impact of antiretroviral therapy on patients is variable and a standardised approach to professional advice is unlikely to be effective. A greater understanding of individual patient perceptions of therapy and potential issues with integrating these complex regimes into their daily living may assist HCPs deliver more effective patient services.

References

1. MacIlwain C. Better adherence vital in AIDS therapies. Nature 1997; 390:326.
2. From compliance to concordance: achieving shared goals in medicinetaking. The Royal Pharmaceutical Society of Great Britain, London 1997.