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Doctor overly zealous in treatment adherence?
Jun 29, 2010

My husband just started taking Isentress and Truvada (his first treatment since he was diagnosed). When he asked the doctor about the timing of the Raltegravir (Isentress) and how exactly he needs to keep the interval at 12 hours (he takes it at 8am and 8pm) the doctor's response was that he should keep it to within 20 minutes of 8am or 8pm. My partner who ironically is in the field of HIV prevention and has experience with treatment adherence was stunned but he is religiously adhering to this recommendation even though we freak out if he's five minutes off schedule. We know Isentress has a low resistance barrier but this seems excessive.

Recently pilot studies have indicated that Isentress is effective at double the dose once a day and that it will probably be approved for such use in the not too distant future. My husband's doctor is part of one of the nation's best ID practices but he is admittedly "extremely conservative" about this stuff. He espouses the risks of oral sex even though EVERY other doctor we have ever met says the risk is practically zero, if not zero.

Is he being overly strict in his recommendation of 12 hours give or take 20 minutes and if he should take the medication an hour off here or there every once in awhile would it be risky or is the doctor just trying to scare him into staying as close to the 12 hours as possible?

Response from Dr. Young

Hello and thanks for your post.

In my opinion, I think that the 20 minute rule is a bit strict. Indeed, evidence-based medical review of the literature would show that the pivotal clinical trial for Isentress simply stated that the dosing be twice daily (not every 12 hours, on the second).

I don't think this is one to go to the mat over (so-to-speak), but clearly, being regular about dosing is an important element for long-term success.

I hope this helps and wish you both well.

BY



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