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TABLE 29: Possible reasons for poor adherence. Ethical consideration
Individual Provider Medication
Depression Stock-outs High pill burden This article followed all ethical standards for carrying out
Alcohol or substance use Inaccessible clinics Frequent dosing (more research without direct contact with human or animal
(both in place and time) than once per day) subjects.
Non-disclosure Poor communication Adverse effects
(not patient-centred)
Inadequate treatment literacy - - Funding information
Adolescence - -
Following pregnancy - - This research received no specific grant from any funding
Food security - - agency in the public, commercial or not-for-profit sectors.
Work-related issues (shift work) - -
Social problems (stigma and poor - -
social support networks) Data availability statement
Data sharing is not applicable to this article, as no new data
should be encouraged and supported to take their dose were created or analysed in this study.
once they remember to do so in these instances.
ÿ Disclosure is not a prerequisite for ART. Disclaimer
ÿ Heavy alcohol use may affect adherence and may
potentiate ART hepatotoxicity and other hepatic Specific recommendations provided here are intended only
pathology; however, responsible alcohol use is not as a guide to clinical management, based on expert consensus
prohibited in patients established on or starting ART. and best current evidence. Treatment decisions for patients
should be made by their responsible clinicians, with due
Patients should be informed about the benefits of ART and consideration of individual circumstances. The most current
that side effects are usually minor and transient, or version of this document should always be consulted.
manageable. They should be given a treatment plan,
specifying the drugs to be used (with names and details 30. Abbreviations
including the appearance of each drug, when and how they
are to be taken, and a brief indication of anticipated side /r ritonavir-boosted
effects and toxicity). 3TC lamivudine
ABC abacavir
The causes of poor adherence are often complex and ADR adverse drug reaction
linked to social issues. Common causes are outlined in AKI acute kidney injury
Table 29. ALP alkaline phosphatase

° Common pitfalls: ALT alanine transaminase
° Not informing patients about the benefits of ART. ART antiretroviral therapy
This includes not only reduced mortality and ARV antiretroviral
morbidity, but also prevention of HIV transmission. AST
° Not informing patients that side effects are usually aspartate transaminase
ATV atazanavir
minor and transient, or manageable.
° Not advising patients on how to deal with delayed ATV/r atazanavir/ritonavir
dosing. AZT zidovudine
° Not providing patients with a treatment plan bd twice daily
specifying the drugs to be used. CD4 + cluster of differentiation 4
CM cryptococcal meningitis
29. Acknowledgements CrAg cryptococcal antigen

The authors would like to acknowledge the Southern African CrCl creatinine clearance rate
HIV Clinicians Society for their support. CSF cerebrospinal fluid
CT computed tomography
Competing interests CTX Cotrimoxazole
CVS cardiovascular
The authors have declared that no competing interests exist.
CYP cytochrome P450
Authors' contribution d4T stavudine
ddI didanosine
J.N., S.D. and G.M. constituted the writing committee and DILI
were the primary authors of the manuscript. The other drug-induced liver injury
authors reviewed the manuscript and offered constructive DNA deoxyribonucleic acid
criticisms. DRV darunavir

http://www.sajhivmed.org.za 54 Open Access