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lost medication while on holiday
Jul 16, 2006

hi,i'm a guy from London[England]i'm currently on holiday in Thailand and some of my luggage got stolen from my hotel room. my hiv medication went missing too and i dind't manage to get them replaced till late at night on the day after they went missing. this means i could not take my morning combivir tablet and took 4 hours later then normal my evening combivir and sustiva tablets. i've been successfully on this conbination for over 4 years,my viral load is undetectable and my cd4 count from 200 went up to 650.i'm supposed to stay here 3 more weeks and i managed to get enough medication to cover the rest of my holiday, yet i wonder if this accident might have seriously compromised the success i'm experiencing from my current treatment and if i should consider going back to london to take a test and find out. thank you again for all the very useful information you are providing on this site. kind regards andreas

Response from Dr. Sherer

The degree of delay in your ART that you describe should not increase your risk of resistance, for three reasons.

First, a single four hour delay in taking Sustiva should not lead to sub-therapeutic levels of the drug in most circumstance, as the drug levels achieved by Sustiva are many times the necessary dose to stop viral replication, and Sustiva's half life in the blood is 40 hours or so.

Secondly, the NRTIs act intracellularly, and effective levels of combivir last for 12 hours or more; in general, a single missed dose of combivir carries only a very low risk of resistance.

And finally, when a person has an undetectable viral load and stops ALL medication, there is a lapse of 5-7 days before detectable viral loads occur in the plasma. A single missed dose of ART, while NEVER a good idea, is a lesser threat to one who has already achieved a viral load below detection, as compared to a person who recently started ART and still has viral loads in the tens or hundreds of thousands.

WHen you return to London, I urge you to share this experience, and these observations with your doctor.


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