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How to adjust meds to overseas time difference.
Feb 11, 2001

Dear Doctor; Thank you for your valuable time and help.My question is this my partner and I are going to Australia.We take our meds at 0930 -2130 hrs.How do you adjust your med scheduling without risking a time lapse and risk a resistance to your meds.I believe its an plus 18 hours.Thank you for your help.

Response from Dr. Cohen

If you're calling it 18 plus hours - you likely live somewhere on the east coast of the States, if I can do the math. And I'd guess you were going in Feb for Mardi Gras?

The easy way to answer your question is that you just stay on the meds in your current time frame, ignoring what time the clock says over down there. However - that would potentially prove difficult, since the 930 AM dose becomes 330 in the morning - and you may or may not be up at the hour... Similarly the 930 pm dose would be 330 in the afternoon there - and you may be just fine, or just in the middle of sleep... depending.

So if these times don't work, then you'd need to adjust. Most of our meds have some "wiggle room" and you have a few hours to work with - so the new time could be a bit later, like 6 AM and 6PM over there for example. Two factors have some influence in how much flexibility there is - first is which meds. Some are taken twice a day but actually have a longer "half life" in the body so can easily be adjusted since there is flexibility. Others are less flexible however - meaning around 12 hours the levels are getting low enough on average to make it more important to take a dose - this is mostly true for the protease inhibitors that are taken without a "booster" like ritonavir. If you're in that situation - you might just take the next dose earlier than you need to and adjust from there - meaning take a dose a 930 am, and the next earlier, like 9 hours later to get on a schedule that could work while on vacation. Then the same would be true coming back over.

One other factor that may help - which is how long you are on them and how low the viral load is. If you have started them recently, or have some ongoing viral load - then being more strict about the timing is reasonable to not give HIV any chances. However - if your viral load is well suppressed, e.g. below 50 for some time - then even if you were even several hours late with your next dose - it likely won't matter.

But the easiest way is just to take it earlier than you need to and go from there.

And have fun - it is a beautiful place.

PS take all meds as carry on luggage - never check your meds in the baggage just in case! And don't forget to either move about a bit or take an aspirin if you can do so pre flight - there is some possibility that persons with HIV can be somewhat more prone to form blood clots - and this is a new and growing concern on these long flights!

CC



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