Dr. Bob, I don't know what is wrong with me... I have been positive for 4 years. I went through a very hard time in the first 2 years of therapy. Severe anemia a lousy doctor. I changed all of that and now I am doing great. I feel like I have my life back. I have the job of my dreams, a wonderful home, and a precious son. I just can't seem to make myself adhere to my regime. I am an intelligent man who knows the truth. I am avoiding going to the doctor. I am now afraid to go to see the doctor because I know that he will be angry at my stupidity. Is this normal? I don't know what to do.

j

Hello J,

Strict adherence to any medical regimen is difficult. Did you know that a large percentage of doctors can't even strictly adhere to a 10-day course of antibiotics, let alone a lifetime of antiretrovirals! Strict adherence to antiretroviral medications is made all the more difficult by many factors, including:

1. each dose reminds us we are HIV infected;

2. the potential side effects and toxicity profile of these medications is often frightening;

3. some have inconvenient dosing schedules or food restrictions;

4. some have drug-drug interactions;

5. the adherence must be nearly perfect to avoid the development of drug resistance;

6. the therapy is lifelong; and

7. the long-term consequences of taking these potent drugs are unknown.

You are not alone in having difficulty adhering to your medications. It's a very common problem among us HIVers. It has nothing to do with intelligence. I urge you not to avoid your doctor. I can assure you HIV specialist physicians deal with this problem on a daily basis. Your doctor may be disappointed you have not been faithful to your drug regimen, but he should not get angry. He may well try to explain once again the importance of strict adherence and he may make his point forcefully. But this should be only to emphasize a point, not to vent his anger. I would suggest you make an appointment to see your HIV specialist ASAP. Begin the visit by confessing that you have not been adhering to your medications. Immediately explain to him that you know the potential consequences of non-adherence (development of drug resistance) and you want his help. He'll evaluate potential factors contributing to your non-adherence side effects, dosing schedule, poor memory, food restrictions, pill burden, etc. Together you should be able to find an effective regimen that you can adhere to.

Good luck.

Dr. Bob