Based on federal guidelines, the goal of antiviral combination therapy remains to reduce HIV activity to as low a level as possible for as long as possible. There's increasing evidence that driving viral load to below 50 copies increases the chance of keeping the virus down over time. Other studies show even a threefold decrease in viral load has health benefits. Beyond that, the best shot is one that looks carefully at a patient's medical and treatment histories, tolerance of a given regimen, and factors that might be influencing the drugs' ability to work, including nonmedical issues like cost and convenience. In a recent survey of problems affecting patient adherence, Calvin Cohen, research director of the Community Research Initiative of New England, cited a dozen reasons why people failed to religiously follow their drug regimens, including emotional and psychosocial factors such as depression or a distrust of Western medicine in general.
Several surveys show the most common reason for poor adherence is forgetting to take one's pills.
That's a problem, says Cohen, that can be addressed by simple strategies like getting patients to use a portable alarm. The point is, just as there's no blueprint for how therapies will work, there's no blueprint for how a given patient will manage HIV therapy. And as HIV activists point out, the same can be said of physicians. Some are more on top of things than others. That's why the federal guidelines recommend seeking care from a doctor who's experienced with HIV treatment.