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To the Editor.—In their article on antiretroviral therapy and drug resistance in human immunodeficiency virus (HIV) infection, Drs Wainberg and Friedland¹ extensively review the topic and conclude with the importance of patient adherence to prescribed drug regimens. However, as with most articles on this subject, the authors fail to mention the role of clinicians in prescribing HIV-1 antiretroviral therapy and their lack of training in understanding the complexities of adhering to complicated medication regimens.

A recent descriptive study of 202 patients with HIV infection identified incorrect dosing schedules, suboptimal dosages, and/or protease inhibitors ordered as monotherapy in 39.6% of the medical orders.² All of these problems will contribute to subtherapeutic blood levels of the drugs and promote drug resistance.

The majority of health care professionals do not receive formal education in assessing, teaching, and supporting their patients in adherence. While well intentioned, we have used traditional patriarchal approaches in . . . [Full Text of this Article]

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RELATED ARTICLE

Public Health Implications of Antiretroviral Therapy and HIV Drug Resistance
Mark A. Wainberg and Gerald Friedland
JAMA. 1998;279(24):1977-1983.
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