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Missed A Dose
Jun 27, 2004

Damn, I wish I could pick up the phone and call one of you right now. You've each been so helpful to me in the past

Haven't written in a while because everything's been going relatively well. Six months into treatment, my VL has dropped from over 850,000 to just 60 a month ago. I'm scheduled for my next monthly check-up tomorrow morning (I'm part of a clinical trial), and was really hoping that I'd finally reach undetectable this time.

But I just went to take my nightly Sustiva-Epivir-Viread dose and discovered to my horror that I forgot to take my dose last night. Dont know how it happened, but there it is. Now, after six months of literally perfect adherence, I'm panicking that I've totally screwed everything up in one night. (Im not kidding: I actually started crying, which I NEVER do!)

Can I develop resistance from missing just one dose in half a year? And should I expect a viral blip when I get the results from tomorrow morning's blood work?

Don't know how I'll get to sleep tonight...

-D

Response from Dr. Pierone

Hello, glad to hear that your numbers are improving. Your viral load should be undetectable even though you missed a dose of medication.

We preach 100% adherence and strongly advise people on therapy not to miss any medication. This has not changed.

The following may sound heretical, but please bear with me. Much of the gospel on adherence and resistance comes from studies done with less potent and shorter acting medications. There are new data regarding the forgiveness of contemporary regimens.

Sustiva has been shown to maintain adequate levels in the blood for antiviral activity for 1 to 2 weeks (sometimes longer). Viread has adequate levels at least several days and Epivir levels persist for 1 or 2 days. There are data due to come out in several weeks in Bangkok at the International AIDS conference that detail the use of Sustiva (and Viramune)-based therapy in a 5 days on, 2 days off schedule. Additionally, we have previous pilot studies showing that Sustiva-based therapy also works on a 7 day on, 7 day off schedule. The NIH has a larger study underway of 7/7 to confirm the previous results.

Please don't anyone take this information to suggest that adherence is not vitally important, it remains the most important aspect of HIV management. These are pilot studies and no one is endorsing taking weekends off. However, if these strategies are proven effective, it would be great to be able to give people weekends off their medications. Not ready for prime time. Again, don't do this now!



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