Pharmacy World & Science

, Volume 29, Issue 4, pp 422–429 | Cite as

Common problems with antiretroviral therapy among three Swedish groups of HIV infected individuals

  • Amadou JallowEmail author
  • Sofia Kälvemark Sporrong
  • Lilian Walther-Jallow
  • Peter M. Persson
  • Urban Hellgren
  • Örjan Ericsson
Research Article



The main objective of this study was to identify and compare the common problems and difficulties associated with combination antiretroviral therapy (CART) as experienced by three major groups of HIV infected individuals (homo- or bisexuals, former injecting drug users and origins of Sub-Saharan Africa) in Sweden.


Based on the results from in-depth interviews with 15 representatives from the three major groups, a questionnaire was designed for use in a problem detection study (PDS). The study was conducted with 195 HIV-positive patients residing in the major cities of Sweden.


The overall response rate was 79%. The problems identified in all three groups were negative attitudes from the public, worries about disease progression or therapy failure, medication or drug-related problems and problems in connection to pharmacy visits. A specific problem in the homo- or bisexual group was drug-related problems such as adverse effects, drug interactions and pill burden. For former injecting drug users, the specific problem was disease-related conflicts with relatives and the problem of coping with the social and psychological burden caused by the HIV infection. The African group termed the risk of exposing their medication at the pharmacy as a specific problem, as this could reveal their HIV status.


Our findings regarding problems with CART in three patient groups in Sweden may be of use to tailor pharmacy care to HIV infected individuals.

General strategies to improve adherence need to be complemented with approaches that will address the specific needs for the different patient groups affected by HIV. Further studies on group-specific interventions that promote concordance and adherence to CART will be necessary to minimize therapy failure and viral resistance.


Adherence AIDS Antiretroviral therapy Concordance Drug-related problems Drug-use problems HIV Patient counselling Sweden 



The authors thank Sveriges Farmaceutiska Sällskap for awarding a scholarship to the project and Pharmacist Lena Lagerholm for assistance. Special thanks to the staff of RFHP (the Swedish Group for HIV Positives), CONVICTUS (former injecting drug users) and OASEN (group for origins of Sub-Saharan Africa) for their invaluable support in collecting the study data. Thanks to the Pharmacist Mr and Mrs Mgbemena for reading the final stage of the manuscript.


This work was funded by the National Corporation of Swedish Pharmacies (Apoteket AB) and the Swedish Foundation for Strategic Research.


  1. 1.
    Palepu A, Tyndall M, Yip B, O’Shaughnessy MV, Hogg RS, Montaner JS (2003) Impaired virologic response to highly active antiretroviral therapy associated with ongoing injection drug use. J Acquir Immune Defic Syndr 32:522–526PubMedCrossRefGoogle Scholar
  2. 2.
    Sherer R (1998) Adherence and antiretroviral therapy in injection drug users. JAMA 280:567–568PubMedCrossRefGoogle Scholar
  3. 3.
    Moore RD, Keruly JC, Chaisson RE (2004) Differences in HIV disease progression by injecting drug use in HIV-infected persons in care. J Acquir Immune Defic Syndr 35:46–51PubMedCrossRefGoogle Scholar
  4. 4.
    Swan T, Raymond D (2004) Care of patients with hepatitis C and HIV co-infection. AIDS 18:1745–1746PubMedCrossRefGoogle Scholar
  5. 5.
    Celentano DD, Vlahov D, Cohn S, Shadle VM, Obasanjo O, Moore RD (1998) Self-reported antiretroviral therapy in injection drug users. JAMA 280:544–546PubMedCrossRefGoogle Scholar
  6. 6.
    Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS et al (1998) Barriers to use of free antiretroviral therapy in injection drug users. JAMA 280:547–549PubMedCrossRefGoogle Scholar
  7. 7.
    Paterson D, Swindells S, Mohr J, Brester M, Vergis EN, Squier C et al (1999) How much adherence is enough? a prospective study of adherence to protease inhibitor therapy using MEMS caps. In: Program and abstracts of the 6th Conference on Retroviruses and Opportunistic Infections; January 31–February 4, Chicago, 1999Google Scholar
  8. 8.
    Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C et al (2000) Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 133:21–30. Comment in Ann Intern Med 2001;134:625. Erratum in: Ann Intern Med 2002;136:253Google Scholar
  9. 9.
    Chesney M (2000) Adherence to HIV medications. Clin Infect Dis 30(suppl 2):642–660Google Scholar
  10. 10.
    van Sighem AI, van de Wiel MA, Ghani AC, Jambroes M, Reiss P, Gyssens IC, Brinkman K, Lange JM, de Wolf F (2003) ATHENA cohort study group. Mortality and progression to AIDS after starting highly active antiretroviral therapy. AIDS 17:2227–2236PubMedCrossRefGoogle Scholar
  11. 11.
    Jensen-Fangel S, Pedersen L, Pedersen C, Larsen CS, Tauris P, Moller A, Sorensen HT, Obel N (2004) Low mortality in HIV-infected patients starting highly active antiretroviral therapy: a comparison with the general population. AIDS 18:89–97PubMedCrossRefGoogle Scholar
  12. 12.
    Mocroft A, Brettle R, Kirk O, Blaxhult A, Parkin JM, Antunes F, Francioli P, D’Arminio Monforte A, Fox Z, Lundgren JD (2002) EuroSIDA study group. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS 16:1663–1671PubMedCrossRefGoogle Scholar
  13. 13.
    Harrigan PR, Whaley M, Montaner JG (1999) Rate of HIV-1 RNA rebound upon stopping antiretroviral therapy. AIDS 13:F59-F62PubMedCrossRefGoogle Scholar
  14. 14.
    Nieuwkerk PT, Sprangers MA, Burger DM, Hoetelmans RM, Hugen PW, Danner SA et al (2001) Limited patient adherence to highly active ART for HIV-1 infection in an observational cohort study. Arch Intern Med 161:1962–1968PubMedCrossRefGoogle Scholar
  15. 15.
    Kleeberger CA, Phair JP, Strathdee SA, Detels R, Kingsley L, Jacobson LP (2001) Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr 26:82–92PubMedGoogle Scholar
  16. 16.
    Montaner J, Hogg R, Yip B, Wood E, Harrigan R, O’Shaughnessy M (2001) Further characterizing determinants of disease progression among HIV-1 infected patients initiating triple drug therapy. In: Program and abstracts of The 1st IAS Conference on HIV Pathogenesis and Treatment; July 8–11, Buenos Aires, ArgentinaGoogle Scholar
  17. 17.
    O’Brien ME, Clark RA, Besch CL, Myers L, Kissinger P (2003) Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort. J Acquir Immune Defic Syndr 34:407–414PubMedCrossRefGoogle Scholar
  18. 18.
    Elion R, Cohen C, DeJesus E et al (2004) Col40263: resistance and efficacy of once-daily Trizivir and tenofovir DF in antiretroviral naive subjects. Presented at the 11th Conference on Retroviruses and Opportunistic Infections; February 8–11, San FranciscoGoogle Scholar
  19. 19.
    Jemsek J, Hutcherson P, Harper E (2004) Poor virologic responses and early emergence of resistance in treatment of naive, HIV-infected patients receiving a once daily triple nucleoside regimen of didanosine, lamivudine, and tenofovir DF. Presented at the 11th Conference on Retroviruses and Opportunistic Infections; February 8–11, San FranciscoGoogle Scholar
  20. 20.
    Kaul DR, Cinti SK, Carver PL, Kazanjian PH (1999) HIV protease inhibitors: advances in therapy and adverse reactions, including metabolic complications. Pharmacotherapy 19:281–298PubMedCrossRefGoogle Scholar
  21. 21.
    Safrin S, Grunfeld C (1999) Fat distribution and metabolic changes in patients with HIV infection. AIDS 13:2493–2505PubMedCrossRefGoogle Scholar
  22. 22.
    Zolopa AR, Shafer RW, Warford A, Montoya JG, Hsu P, Katzenstein D et al (1999) HIV-1 genotypic resistance patterns predict response to saquinavir-ritonavir therapy in patients in whom previous protease inhibitor therapy had failed. Ann Intern Med 131:813–821PubMedGoogle Scholar
  23. 23.
    Romano L, Venturi G, Giomi S, Pippi L, Valensin PE, Zazzi M (2002) Development and significance of resistance to protease inhibitors in HIV-1-infected adults under triple-drug therapy in clinical practice. J Med Virol 66:143–150PubMedCrossRefGoogle Scholar
  24. 24.
    Wainberg MA, Friedland G (1998) Public health implications of antiretroviral therapy and HIV drug resistance. JAMA 279:1977–1983PubMedCrossRefGoogle Scholar
  25. 25.
    Little SJ, Holte S, Routy JP, Daar ES, Markowitz M, Collier AC, et al (2002) Antiretroviral-drug resistance among patients recently infected with HIV. New Engl J Med 347(6):385–394. Comment in: N Engl J Med 2002;347(6):438–439. N Engl J Med 2002;347(23):1889–1890:author reply 1889–1890Google Scholar
  26. 26.
    Deeks SG (2003) Treatment of antiretroviral-drug-resistant HIV-1 infection. Lancet 362:2002–2011PubMedCrossRefGoogle Scholar
  27. 27.
    Sanne I, Piliero P, Squires K, Thiry A, Schnittman S (2003) AI424–007 Clinical trial group. Results of a phase 2 clinical trial at 48 weeks (AI424–007): a dose-ranging, safety, and efficacy comparative trial of atazanavir at three doses in combination with didanosine and stavudine in antiretroviral-naive subjects. J Acquir Immune Defic Syndr 32:18–29Google Scholar
  28. 28.
    Rosenqvist U, HÖglund A, Nilsson JLG (1995) Diabetes mass education for patients. Drug Inform J 29:609–616Google Scholar
  29. 29.
    Lisper B, Nilsson JL (1996) The asthma year in Swedish pharmacies: a nationwide information and pharmaceutical care program for patients with asthma. Ann Pharmacother 30:455–460PubMedGoogle Scholar
  30. 30.
    Wade AH, Weir DN, Cameron AP, Tett SE (2003) Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy. J Hum Hypertens 17:397–405PubMedCrossRefGoogle Scholar
  31. 31.
    Bertholon DR, Rossert H, Korsia S (1999) The patient’s perspective on life with antiretroviral treatment: results of an 887-person survey. AIDS Reader 9:462–469PubMedGoogle Scholar
  32. 32.
    Roberts KJ, Volberding P (1999) Adherence communication: a qualitative analysis of physician-patient dialogue. AIDS 13:1771–1778PubMedCrossRefGoogle Scholar
  33. 33.
    Knobel H, Carmona A, Lopez JL, Gimeno JL, Saballs P, Gonzalez A, et al (1999) [Adherence to very active antiretroviral treatment: impact of individualized assessment]. Enferm Infecc Microbiol Clin 17:78–81PubMedGoogle Scholar
  34. 34.
    Simoni JM, Frick P, Pantalone D, Turner BJ. Antiretroviral adherence interventions: a review of current literature and ongoing studies. Topics HIV Med 11:185–198Google Scholar
  35. 35.
    Haddad M, Inch C, Glazier RH, Wilkins AL, Urbshott GB, Bayoumi A et al. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane DatabGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Amadou Jallow
    • 1
    Email author
  • Sofia Kälvemark Sporrong
    • 2
  • Lilian Walther-Jallow
    • 3
  • Peter M. Persson
    • 4
  • Urban Hellgren
    • 5
  • Örjan Ericsson
    • 6
  1. 1.Apoteket KällanNorsborgSweden
  2. 2.Apoteket ABStockholmSweden
  3. 3.Department of Medicine, Center for Infectious Medicine, Karolinska InstituteKarolinska University HospitalHuddinge, StockholmSweden
  4. 4.Hospital PharmacyKarolinska University HospitalHuddinge, StockholmSweden
  5. 5.Unit of Infectious DiseasesKarolinska University HospitalHuddinge, StockholmSweden
  6. 6.Department of Health and Medical ServicesThe National Board of Health and WelfareStockholmSweden

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