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When AIDS is a secret
Mar 29, 2001

I work at a large company and no one knows I have HIV. I find it difficult to take my meds because of my work schedule. Sometimes we have office parties and the office will eat late. I have to eat early and not again. So I just always say I'm on a diet. But I'm thin and people think I'm crazy. Also I use a watch alarm to help me remember and everyone is always curious when it goes off. I feel so tense about this sometimes. Any tips? Should I change my regimen to something that is only once a day?

Response from Dr. Boyle

You need to discuss this with your doctor as soon as possible. You don't mention whether you are actually missing doses, but it sounds like you are having a great deal of difficulty due to the antiretroviral regimen you are on. Remember that if you are not taking at least 95% of your doses or if you are taking them very late or not following the dietary directions it is highly likely that this nonadherence will eventually lead to failure of the regimen due to resistance. Since cross-resistance affects all of the antiretroviral drug classes, this may greatly limit your future treatment options and success. You don't mention what drugs you are currently on (although I suspect one is Crixivan) or what medications you have been on in the past, and this may affect your options, but there are many antiretroviral regimens that do not have dietary restrictions and have forgiving drug levels/metabolism that allow you some flexibility regarding when you take them and eliminate any dietary restrictions. These include the non-nucleosides (Sustiva and Viramune) and some ritonavir-boosted protease inhibitor regimens (e.g., Kaletra and Crixivan/ritonavir). These can be used in a twice-daily regimen (combining them with nucleosides), but there are some potential once-daily regimens using the currently FDA approved medications (see other answers in this forum). I'm not sure you need a once-daily regimen, but you definitely need a simplified and flexible twice-daily regimen, and so long as you are not heavily antiretroviral experienced, this should be possible. As far as your alarm watch, many of my patients complain of the same thing. Some companies now have beepers (some that vibrate rather than beep) or cellular telephones that are not so obvious and you can ask your doctor to direct you to one of them. Some pharmacies provide them free of charge to help patients with adherence. Good luck and let me now the regimen your doctor selects. BB



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