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How off schedule is off?
Jul 19, 2001

I was diagnosed as HIV positive in Nov. of 2000 and have been a on a successful regimen that includes Kaletra (3 pills 2x a day), Videx EC (400mg 1x a day) and Ziagen (300mg 2x a day). I have endeavored to be as faithful as can be to my pill taking, but I have some questions that may not have empirical answers, but that you may have a better opinion on, than say I do.

What constitutes drug therapy compliance? Taking your Rx's at exactly the same time every day? Within one hour? Two hours? Three hours?

To be truthful - have been three hours off my exact time on three or four occasion, but these are the only deviations from the prescribed regimen of any note - are they allowable?

When does a patient achieve a steady-state of drugs in her/his system?

When does resistance start to show up? And is it inevitable even with perfect or near perfect drug compliance?

Thank you for answering these questions for me. I check 'The Body' often and find that the dialogue you and the others Doctors provide to be a great help.

Response from Dr. Boyle

Lots of good and interesting questions. First, you should try to take Kaletra (lopinavir/ritonavir) and Ziagen (abacavir) as close to every twelve hours and Videx EC (didanosine) as close to every 24 hours as you can, with the Videx EC being taken on an empty stomach. These medications are pretty forgiving, however, so occasionally being late by a few hours is not likely to be a problem. By definition, compliance (or adherence) means taking your medications as your doctor directed. Based upon what you are saying (i.e., that you take every dose but occasionally you're a few hours late), I would classify you as compliant/adherent. Steady state with drugs is reached after the 4th or 5th dose. It is unclear at this point whether resitance is inevitable...some patients have been on the same regimen for as long as five years and are still doing well with it. Will they eventually have HIV resistance to their current antiretrovirals develop? Maybe, but by then it probably won't matter because there will be a lot of other treatment options. The key is to be compliant/adherent with your medications since this severely limits the amount of viral replication and the chance for HIV resistance to develop AND this buys time so that you remain healthy while further research is done and treatment options are developed. Good Luck!


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