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Missed doses
Sep 28, 2007

Dear Doctor, I am on a regimen of Truvada, Norvir, Lexiva, and missed three days (six doses) of my Lexiva, but had the Norvir and Truvada to take--long story, but I know NO EXCUSES. How long will it take to know if these missed doses will make me resistant, and how will I know this. I just had counts done and still undetectable about three weeks after these missed doses. Also, how precise do I need to be about pill taking times? I take my meds twice daily, between 9-11am and 9-11pm, and my doc said this two hour window was ok? Thanks for your advice!

Response from Dr. Sherer

Regarding the last question, I agree with your doctor, the 2 hour window is likely to be safe for twice daily dosing.

To anwer your question properly, it would help me to know if these events occured during a period in which you were fully suppressed, i.e. your last viral load was below the level of detection, and your CD4 cells were rising, and your adherence was excellent. If that is the case, then the likelihood of these three days leading to resistance is relatively low. In some of the treatment interruption strategies involving short intervals such as one week on and one week off, it appeared that full scale viremia did not occur following complete suppression for 5-7 days.

If, on the other hand, you were just starting the treatment in the presence of a high viral load, or you have not had full suppression when these events occured and there was viremia, I would be more concerned about possible drug resistance.

In either case, you and your doctor can test for resistance by repeating the CD4 cell count and viral load, and, if the viral load is > 1,000 copies/ml, your doctor can order a resistance test to look for resistance mutations.

Your story offers a good lesson for anyone with HIV on medication. Always be sure to have a full supply of ALL of the drugs in the regimen, and plan ahead so that you don't run out of one or another of the drugs in the regimen. Excellent adherence means that you take ALL the drugs in the regimen at the prescribed dose and interval.

As above, I urge you to talk to your doctor and work out a drug supply plan to avoid a similar occurence in future.

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