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HIV Drug ResistanceHIV Drug Resistance
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taking meds at the EXACT same time
Mar 1, 2008

Dear Dr. Sherer: Thank you so much for all the time you give to all of us. My adherence is almost perfect and has been for 17 years. Being a long-timer, I have developed drug resistance. I'm on a regimin now of Norvir, Prezista and Epivir. The "almost" perfect comes in because at times I take my meds a little off schedule. For example, I take my nighttime meds at 7:30 but then take them at 9:00 in the AM. Is this acceptable, or must I set an alarm. I'm never more than 2 hours off. I know how important adherence is, but it's also difficult at times to live such a regimented life. Thank you!

Response from Dr. Sherer

You and your doctor might be better equipped to answer this question than I. You have had drug resistance in the past - was this due to sub-opimal regimens before the HAART era? Was there any evidence in the HAART era that your adherence patterns might also have contributed to new resistance mutations and virolgic failure of a regimen that might have been expected to give you durable suppresion? One useful tenet of adherence is to learn what works for you, among the accepted options that your doctor offers you, and then stick with it.

Having said all of that, I would probably be tolerant of the practice that you describe if you were in my practice, though I would be quick to let you know that it is less than optimal. I try to tell patients to take their doses within one hour of the exact time...and then I make sure that they know that I don't expect them to be perfect.

So my answer is...what you're doing with this boosted PI regimen with a known prolonged half life and high drug levels is probably OK...but if you could modify this even minimally to take that evening dose at 8pm, and then sometimes in the am at 9am, that would be better than a longer interval. My concern is that if the practice is regularly late by 1.5 hours, will it occassionally be late by 3 or 4 hours? This of course would be worse still.

I suggest that you let your doctor be the final judge, and work out the best strategy with him or her.

When to start meds?
Update: Resistance/Symp

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