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.
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.
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