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HIV meds and adherence with work schedule
Jun 25, 2003

Hey guys,

I'm writing to see if you can help think of a solution to a rather difficult problem.

My work requires 90 travel. The type of travel is 4 cities in 5 days Monday - Friday.

I have some meds that require refridgeration, some have to be eaten with fat - others on a dry stomach. The number of pills is astonishing.

I've tried three times to start meds with this schedule - and in spite of my best efforts - I'll leave hotel A and get to city B and realize - oops - my ritanovir is back in Philadephia. This happens with such alarming frequency - that I opted not to take meds.

I truly believe that when I take meds - my short term memory is adversely affected. I also do not believe it is possible to take these complex pills with their various food requirements when not being at home.

My Dr. tells me I'm full of it - and he has patients who travel and adhere. I leave his office feeling bad about myself every time.

Is there a combination I can take that doesn't require so many different food requirements - refridgeration - etc.? Only things I can't take are sustive and AZT (due to genotyping).

Response from Dr. Pierone

Hello, sounds like a difficult problem. It really seems that beyond the challenges in dosing and scheduling that you may be having significant medication related side effects. The refrigeration issue with ritonavir is overblown; with the new formulation the pills are stable at room temp for longer than 30 days. The bottle should be refrigerated, but your pill box can be at room temp to simplify your routine. Also, the enhancement of blood levels of other protease inhibitors that occurs with ritonavir sometimes makes food restrictions less critical.

To answer your question about an alternative regimen it would be necessary to know what your current regimen is (even though you are off meds), the virus resistance mutations, previous medication intolerances, CD4 count, and viral load.

It also sounds like you dont have a very good relationship with your doctor since you leave feeling bad every time. This is a big problem and things are not going to work out unless something changes. A serious attempt to establish better communication is in order to try and salvage this relationship.

Good luck.



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