I found out I was poz in early 2005. I have taken my meds as I should have been since starting the meds in late 2005. I have not missed a dose since I started. I was on the Ryan White program at my doctor's office when I first got diagnosed, but recently was informed that I would have to pay full price for my lab work and exams. I can't afford going every 3 months like they want me to. I have missed my last appointment because of this, and they won't give me a refill on my meds. I was wondering what, if any, is a safe timeframe where you don't become drug resistant. At this point I'm starting to get worried that I'm building up a resistance. Is there any advice you can give me?

I am dismayed to hear that your ART is unavailable to you due to lack of funds to pay for the monitoring labs. This situation needs urgent attention, and I believe you should be able to find a way to continue receiving your ART and getting the laboratory support that you need, if you are willing to persist and do some leg work. I will answer your question, and then return to this point below.

Each unscheduled interruption of taking your ART drugs as prescribed carries a small but real risk of drug resistance. Missing several doses in a row and essentially discontinuing the drugs further increases that risk. Once you have completely stopped the medications, there is no further risk of 'building up' resistance. The amount of time that can pass before this becomes a critical threat to your health depends on many factors, such as your current CD4 cell count, your lowest ever CD4 cell count, your response to the ART, the type of ART, and others.

While it would be better not to have had this experience, you still have an excellent chance of responding to an ART regimen, whether it is the same regimen you have been taking, or a different one that is required because you have developed resistance to one or more of the drugs in the regimen you used to be taking.

Your situation is unfortunately too common around the world and in the US. ART drugs and the labs required to monitor them do cost money, though they are cheap and highly cost effective compared to other commonly prescribed medications.

My advice to you is to encourage you to seek assistance from one of a variety of possible sources of support for your lab tests, and for your ongoing source of ART drugs. The ADAP hotline in Chicago is 800-825-3518, and they should be able to direct you to the ADAP hotline in your state.

Also, there is likely to be an HIV advocacy program in your state - have you tried to talk to an HIV case manager or social worker about this situation? You can find such a person or agency in your state by calling the AIDS Foundation of Chicago (312-922-2322, or www.aidschicago.org).

Finally, if all else fails, you can fax your name, address, and physician's name and phone number to me at 773-702-8998, and I and my social worker will refill your medications (on a temporary basis) while we try to find a care facility that can cover the costs of your monitoring labs. Please identify yourself by referring to this internet exchange in the fax.

Finally, I encourage you to talk to your doctor about all of this. Is he or she aware of your situation? Many HIV physicians have case managers, social workers, nurses, peer educators or volunteers that can help them with this type of problem. And your doctor is in the best position to answer your initial question more informatively than I.