Adhésion au traitement antirétroviral et éthique de la responsabilité : devons-nous prescrire une thérapie antirétrovirale aux personnes non adhérentes ?

Suboptimal adherence to antiretroviral therapy (ART) significantly contributes to a viral breakthrough leading to HIV resistance to treatment. This resistance, in a person living with HIV (PLHIV), may cause the transmission of resistant viral strains to their partners, a major concern for public health. Difficulties in adherence treatment raise an ethical debate: should ART be prescribed for PLWHV who may use them incorrectly? From an interdisciplinary analysis based on the ethics of responsibility framework, one can argue that adherence in the treatment of PLHIV does not solely rely on the individual but also on interpersonal and collective responsibility. Thus, according to philosophers, to assist the poor and the sick is an ethical responsibility. Second, medical ethics states that the foundation of professional practice is based on the obligation to care and treat patients. Third, medical issues associated with the prediction of adherence show that physicians do not have the adequate skills and tools to evaluate and predict it. Interventions based on predictive models and change of non-adherent behaviors seems to predominate in the medical field, although they appear less effective than models of psychosocial theories. Finally, in legal terms, the refusal to prescribe violates rights and freedoms of individuals. Thus, barriers concerning adherence are involved at different levels of responsibility. It would thus be unethical to refuse to prescribe ART to PLHIV under the pretext of non-adherence.