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Could a 1 day incomplete take of meds results in a HIV drug resistant?

Jul 24, 2011

Hi Dr. Bob,

Good day and first of all sorry for the novel. I am currently on Efavirenz + Lamivudine + Tenofovir ARV regimens. I am taking 1 tablet of Efavirenz, 2 tablets of Lamivudine, and 1 tablet of Tenofovir before bed at exactly within range of 11 pm to 12am daily. I have been in these regimen and routines for only 11 months without fail, taking all the meds exactly the same time.

Prior to taking the meds I have been tested for the HIV Genotype (Prostease & RT) and the results are all good. The virus are not resistant to all meds that have tested againts it - this was 11 months ago.

However, today this morning when I'm counting the remainings of my ARV's, I've found out that I have extra 1 tablet on Lamivudine. As far as I remembered, I have not failed on counting the tablets I'm taking daily. To think that it is only 4 tablets at night before sleep.

I actually have a habit of counting how many tablets left on each ARV bottles and this how I found out the extra. Not really sure now, if the bottle of Lamivudine is with 1 extra tablets to total of 61 instead of just 60.

I am now afraid that somehow I have incomplete take of Lamivudine on past nights (However not sure which night it was but pretty sure that last night I am taking the correct number of tablets).

Now, here's my concern and kind of worried about it.

Will this 1 incident could cause the HIV virus in my system to become resistant/immune to the Meds am taking?

I have read somewhere that it is very important not to miss (at most 1 hour) taking the ARV's daily. In my case, there is 1 day that my take is incomplete. My old doctor in Thailand specifically reiterate this as well, and that this is very important to follow the strict routine of taking the meds exactly on the same time daily. Failing to do do could result in drugs resistant, which am dreading to happen.

On the contrary, my current doctor told me that it is okay if i've become late in taking the meds even for 2~3 hours as long as i've been taking it daily.

Please doc, kindly enlightened me especially for that 1 incident of incomplete take of the meds.

Thank you very much. Mr. Worried

Response from Dr. Frascino

Hello, Mr. Worried.

I agree with your current doctor! Most antiretrovirals in use today (including the ones you are using) have a relatively long half-life. Taking your daily dose two to three hours early or late is certainly not a problem.

Adherence to our antiretroviral regimens is indeed important. Certainly we all strive for 100% compliance, but we are all only human and occasionally, despite our best efforts and intentions, we may miss a dose of our medications. I've been on a two- or three-times-a-day regimen dating back to 1996! That's one helluva lot of pill popping. I've managed to miss two doses during this period. Taking antiretroviral medications was much trickier years ago due to food restrictions and every-eight-hour dosing, particularly if you did a lot of international traveling resulting in time zone changes. Regarding your possible missed dose of lamivudine, as they say in Australia, "no worries, mate!" Missing this single dose will not cause you to develop resistance or affect the efficacy of your treatment.

Be well. Stay well.

Dr. Bob

Doctor Bob, 3th donation. Read carefully.
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