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Practical Travel Advice
Mar 1, 2008

I need some practical advice that nobody seems to comment on. Just started Truvada and Kaletra as first regimen as Atripla won't work due to phenotypic testing results.

-0- issues after 3 weeks of taking the Kaletra 2x daily, 7:30AM and 7:30 PM. Maximum "variance" has been 20 minutes and I created an excel sheet for me to keep track. And yes, I celebrated adherence by dinner out last Friday evening.

So, I'm off to an awesome trip to Buenos Aires from Connecticut and find it is now a 3 hour time zone difference!

So, given only 8 days there, what is the best way to stick to adherence given the time zone change...just take my pills at 10:30AM and 10:30 PM and resume when I get back? Or should I gradually adjust an hour each day first 3 days, then the same when I return?

I can find no helpful advice on med adherence when you have time zone issues to deal with.

Practical advice will be much appreciated...and for others that find themselves in the same situation.

Thanks as always!

Response from Dr. Sherer

Your first source of information for this type of question is your doctor. Did you ask him or her? HIV doctors are very used to this type of question. And your second source might be your pharmacist, particularly if they are practicing in a setting that serves many people living with HIV.

In any event, it's 3 hours later in Buenos Aires. On the day of your flight, I suggest that you leave your watch on EST, take your am dose as usual at 7:30am, and then take your pm dose at 7:30pm EST (which, if you have landed by then, will be 10:30pm Buenos Aires time.) You can then delay the morning dose until 9am Buenos Aires time, and the evening dose at 7:30pm Buenos Aires time, and you will be back on schedule.

This plan will expose you to mildly higher levels than you are used to, and, given your good experience to date, this should not cause additional toxicities.

Do the same on your return flight, but in reverse, as follows: On the day of your return flight, take the dose at 7:30am Buenos Aires time, and leave your watch on Buenos Aires time, and take the next dose at 7:30pm Buenos Aires time (which, if you have landed, will be 4:30pm EST in Connecticut). You will need to get up a little early the next morning, e.g. 6am, to take your next dose, and then resume your usual frequency with a dose at 7:30pm that evening, and 7:30/7:30 thereafter.

This strategy will expose you to slightly lower than usual blood levels on two occasions. Because this regimen has drugs with long half lives and drug levels that are many times higher than the levels needed to inhibit HIV, this strategy should not lead to any reduction in your level of HIV control.

Finally, I might suggest that you ask your doctor about using this regimen once daily. When you have responded well with little toxicity, you are a good candidate to switch to take all of the meds at once, which can make this a more convenient regimen. In two recent trials, is performed comparably to twice daily Kaletra.

As above, I suggest that you ask your doctor about your issue and his or her recommendations for dealing with it. And enjoy the many tangos in the streets of Buenos Aires!


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