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Skipped a dose !
Dec 15, 1999

Hi! and by the way, thanks for a wonderful forum! My question is: I have been taking Zerit, Epivir and Sustiva for 6 weeks now. I seem to be responding very well to therapy, although not undetectable yet. I know it takes more than 6 weeks to get down to undetectable, so I will patiently wait. However, a few days ago, I left in a hurry from my house and forgot to take my morning Zerit and Epivir (Sustiva is once a day, at night). By the time I returned home, it had been about 27-28 hours since my last dose of Zerit and Epivir. Did I compromise the chances of this combination to get me down to undetectable? What is a sfe time limit of unintentional 'drug holiday'? I am sure it varies from drug to drug, but specifically for d4T and 3TC? is the virus able to develop resistance THAT fast? Prior to this, I was therapy-naive.

Response from Dr. Pavia

You are probably fine. It takes quite a while to develop resistance to d4T. While resistance develops more quickly for 3TC, a single missed dose, particularly while you have plenty of sustiva in your blood stream is very unlikely to cause any problems. 3TC has a fairly long half life, so you will still have some around for 24 hours.

It is great that you are trying to be compulsive and that you are worried about a missed dose, but you are doing a good job.

One trick is to use any time you miss a dose as a chance to find a way to avoid the problem in the future. Forget drugs in the morning - consider keeping one extra dose in your desk. Sometimes forget to pack them on trips - prepack a few days worth in a pill dispenser in your toilet kit. You get the idea, just think about fail safe methods for backup on the normal human mistakes. Good luck


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