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Mixed Signals from Doctors & Literature
Nov 10, 2007

Hello,

I have been getting mixed signals from several Doctors as well as some literature I read regarding minor time changes in the time I take my medication. I would greatly appreciate your opinion on this matter. I currently take Atripla once at night time, and due to many reasons, I sometimes take it 1 hour early or 1 hour later then the Ideal 24 hour time frame. Keep in mind I have never missed a nightly dose. Am I putting myself at risk for resistance or is a 1 or 2 hour difference built into the medications.

Thanks for your advise and experience in this matter. You all do great work!

Response from Dr. Sherer

In my opinion, this is exemplary adherence to your regimen, and I do not think that you are increasing your risk of resistance with this behavior.

One advantage of the three drugs in Atripla, i.e. efavirenz, tenofovir, and emtricitabine, is the long half life of each drug in the blood. This long half life will limit the impact of minor variations in the interval between doses, e.g. between 23 and 25 hours.

I am not surprised to hear that different doctors have adopted different positions on this point. I would not fault a physician that the best way to take your medications is strictly according to the package insert every 24 hours, and that ANY deviation from that schedule might increase, even to a low degree, the risk of resistance.

The most important thing that you mentioned is that you have never skipped an entire day, and that is critical with Atripla or any regimen based on an NNRTI like efavirenz or nevirapine. If the interval between doses ever exceeds an hour or two, you should take the next dose as soon as you recognize the oversight (rather than waiting until the next morning).

In your specific case, I think the variation from perfect adherence is still acceptable and unlikely to increase the risk of resistance. I would urge you to talk this through with your doctor.

And I would caution you to keep the interval to a minimum, and not more than an hour on either side of a dose every 24 hours, in order to be on the safe side.


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