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Late Dose
Jul 24, 2004

Hi, Dr. Sherer...

I'm writing today with a timing question. Have been on Sustiva-Viread-Epivir for about six-and-a-half months now, once a day dosing (and in that time have only missed one dose). I usually take all my pills together within a 10:30 p.m. to 12:30 a.m. window before going to bed.

I went to a party last night, got a bit drunk, came home and fell into bed without taking them. Then woke up at 5:30 a.m., remembered, and immediately took the pills. So I guess I was about five hours late... And I plan to take my pills tonight at the regular time. Is this the right thing to do, and has this one incident put me at risk for resistance?

I recently reached undetectable VL after having started treatment with a very high VL (860,000), and I'm concerned about jeopardizing my success.

Best, D

Response from Dr. Sherer

You are correct that your regimen is vulnerable to resistance in the event of missed doses, as both 3TC and EFV require only a single mutation to develop resistance.

According to the available pharmacokinetics of your medications, a delay of 5 hours from your usual timing every 24 hours would increase the risk of resistance by a small degree only. It is not possible to place a number on that risk.

You did the right thing to take the next dose as soon as you realized the oversight, and I would agree with re-establishing your usual routine for medications as soon as possible thereafter.

Finally, I urge you to talk to your doctor about these events. In this case, a slip in adherence was caused by alcohol, a very common occurrence. Perhaps you could plan ahead if you are planning to drink, i.e. take the evening dose a little earlier...and perhaps you could remind yourself to enjoy yourself without drinking too much to forget yourself.

Developing resistance
missed med

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