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Adherence Issues
Mar 21, 2004

I started taking meds 110 days ago. I am on Viramune, Viread, Epivir twice a day. I have missed 4 evening doses and 2 morning doses in the past 100 days. Sometimes I take my morning dose a few hours late but never outside of the 3 hour window I've been told about. If I really clamp down now should I be OK or should I throw in the towel and switch to a once a day treatment? I would like to try to find some new ways to remind myself to take my meds before I change. On the other hand I'm wondering if its worth the risk. How long does it take to build resistance? At what point, if I still haven't manage to achieve the 95 mark, should I ask to be changed to a once a day which I assume would be a change from Viramune to Sustiva. I wanted to avoid Sustiva because of the CNS side effects but I take my chances with nightmares if it means not building resistance.

Response from Dr. Conway

By my count, you are 97% adherent (missing 6/200 doses). Bravo!!!!

I will assume, for the purposes of thsi discussion, that your viral load is undetectable at this point. If it is not, the issues are very different. I would be concerned that resistance to one or more of the drugs you are taking was present before you even started your treatment, and I would do a test on the virus you are now carrying to see if this is the case.

First, I would tell you that you can easily switch to once a day without changing your regimen. I realize that the Viramune label does not support once a day dosing, but we and others have been doing this for years with excellent results. For me, there is NO reason to switch to Sustiva just to go to once a day.

If your viral load is now undetectable, talk to your doctor about switching to once a day to reduce your level of anxiety with adherence, and DO keep up the good work.



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