look is much brighter for patients with HIV infection than it was in 1981, not all patients respond to medication, including those:

  • Who do not have access to state-of-the-art treatment;

  • Who are infected with multidrug-resistant viruses;

  • Who are unable to adhere to treatment regimens; or

  • Who have a relatively small number of usually irreversible complications, such as progressive multifocal leukoencephalopathy.

Furthermore, patients with comorbidities, such as depression, diabetes, and cardiovascular disease, must manage multiple medical therapies (Stoff et al., 2004). The resulting use of multiple medications may lead to further complications and drug interactions. Finally, individuals continue to enter medical care with advanced HIV disease (indicated by low CD4 counts) and suffer from an array of HIV-associated conditions that will likely result in disability for more than one year.

Medication Adherence

Adherence to antiretroviral therapy is widely accepted as crucial to successful outcomes. The level of adherence is reflected by both the suppression of plasma levels of HIV (Aloisi et al., 2002; Lanièce et al., 2003; Nieuwkerk and Oort, 2005) and the individual’s overall quality of life (Mannheimer et al., 2005). Nonadherence to combination antiretroviral therapy regimens, which is common among HIV-positive individuals, compromises clinical effectiveness and is an antecedent to the development of viral resistance (Abel and Painter, 2003; Aloisi et al., 2002; Chesney et al., 2000). It is also associated with increased risk of mortality (Lima et al., 2009). A systematic review of 72 developed-country studies and 12 developing-country studies identified barriers to adherence common to both settings, including fear of disclosure, substance abuse, forgetfulness, suspicion of treatment, complicated regimens, number of pills, quality of life, work and family responsibilities, falling asleep, and lack of access to medications (Mills et al., 2006).

IMPROVEMENTS IN FUNCTIONING AND CAPACITY TO RETURN TO WORK

In most cases, HIV/AIDS is no longer a near-term fatal disease. In these situations, following initiation and stabilization on therapy, patients with HIV infection may engage in a full range of activities, including employment (Goldman and Bao, 2004). Return to work is an important social and economic milestone for HIV-infected individuals and their families, and a



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