title: Concurrent use of complementary and alternative medicine with antiretroviral therapy reduces adherence to HIV medications.
abstract: OBJECTIVE
  Antiretroviral therapy requires strict adherence to ensure therapeutic success. Concurrent use of complementary and alternative medicine (CAM) could alter the adherence to and thereby effectiveness of antiretroviral drugs. This study examined the association of CAM use with adherence to antiretroviral therapy (ART) and CD4 count.
  
  
  METHODS
  The study was conducted in two HIV clinics: one in a semi-urban, the other in a rural area. Adherence to ART was assessed using the Morisky Medication Adherence Scale (MMAS). Data on type of CAM used and MMAS adherence were collected by patient interview and demographic; clinical data were collected from hospital records.
  
  
  RESULTS
  Altogether 212 HIV patients participated in the exit study conducted over 3 months. Almost half (47.9%) used CAM concurrently with antiretroviral drugs. Dietary supplements (40.3%), healing systems (36.5%) and exercise (23.2%) were mainly used. The use of CAM significantly lowered adherence to ART (89.4% in non-CAM users versus 82.5% in CAM users, P = 0.01). Improvement in CD4 count was less in patients using CAM compared to non-CAM users although the difference was not statistically significant (310.5 ± 294.0 cells/L in CAM users versus 224.5 ± 220.0 cells/L in non-CAM users, P = 0.13). Patients attending the rural HIV clinic were more likely to use CAM compared to patients attending semi-urban hospital (χ(2) test = 7.0; P < 0.01).
  
  
  CONCLUSIONS
  Use of CAM could lower adherence to antiretroviral therapy. There is need to develop protocol which could help in monitoring CAM use in HIV patients especially those from rural settings.
authors.affiliation: Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria. obinna.ekwunife@unn.edu.ng
authors.forename: Obinna Ikechukwu
authors.initials: OI
authors.lastname: Ekwunife
authors.forename: Chinekwu
authors.initials: C
authors.lastname: Oreh
authors.forename: Chukwuemeka Micheal
authors.initials: CM
authors.lastname: Ubaka
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003131:Combined Modality Therapy; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003625:Data Collection; D019587:Dietary Supplements; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009549:Nigeria; D019035:Rural Health Services; D019037:Urban Health Services; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents