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A Pharmacist Shows You the Journey to "Undetectable"

November 21, 2013

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Preparing for Your Journey

As you prepare to get your HIV viral load undetectable, there are several things you can do to ensure a successful journey. First, consider your clinician: How's your "patient-provider relationship"? Do you feel your clinician listens to your questions? Are you comfortable having honest conversations about your ART, possible side effects, and any concerns you have about adhering to your regimen? Good communication with your medical team is essential to getting the care you need as you work toward an undetectable viral load.

Next, you'll want to set yourself up to create good adherence habits. Although the studies described above suggest that lower levels of ART adherence may not be as harmful as was once thought, the best way to get (and keep!) your HIV undetectable is to aim for consistent adherence to your regimen.

Make an Adherence Plan

Think about your daily routines and consider where taking your medicines will fit. For example, you probably rarely forget to brush your teeth in the morning, so you might plan to take your medicines right before brushing your teeth.

Also think about what motivates you in other areas of your life. Do you reward yourself after cleaning the kitchen or hitting the gym? Can you motivate yourself with the same (healthy!) rewards after a week of solid adherence to your ART?

Finally, it may be helpful to examine your mindset about taking HIV medications. The pills or injections may at first seem like an unwelcome reminder of your virus, but those drugs also show that you are working to beat that virus, manage your health, and take care of yourself.


Ready Your Adherence Devices

Part of your adherence plan may include using medication reminder devices such as cell phone alarms or daily text messages. Personalizing the alarm or text with a motivating message may help.

ART medication packaging can also make a difference. Some people prefer to keep their medicines in pillboxes marked with the days of the week so they can keep track of the doses they have already taken. Also, some HIV-specialized pharmacies can package ART in pillboxes or in special daily "bubble" packaging.

Try to keep a supply of ART handy and refill your medicines 5-7 days ahead of time so that you don't run out and miss doses. If getting to the pharmacy to pick up your medications is problematic, you may want to talk to the pharmacist about getting medications delivered or mail-ordered. You may also wish to set up automatic refills and reminder calls when your prescriptions are ready.

Assemble Your Support Team

Your adherence plan can also include figuring out who your support network is and assembling a team of "medication cheerleaders." These can be friends, family members, or other people living with HIV -- anyone who can provide encouragement as you start new medications and/or deal with challenges to adherence.

You might ask this team to check on you in person, by phone or text, or online. If you are taking a drug that may cause depression or other psychiatric side effects, you might consider asking your support team to watch out for these symptoms and be prepared to help you seek assistance. Sometimes just knowing that people are watching out for you can be comforting and motivating.

Lastly, don't forget to ask for help from your health care team: your doctors, nurses, pharmacists, social workers, case managers, and others who are rooting for you to succeed in your journey to undetectable.

Jennifer Cocohoba, Pharm.D., is an associate clinical professor in the School of Pharmacy at the University of California, San Francisco (UCSF). Since 2004, she has worked as the clinical pharmacist for the UCSF Women's HIV Program, where she provides adherence support and medication information to patients and providers.

Selected Sources

Bangsberg, D. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clinical Infectious Diseases 43(7):939-41. October 1, 2006.

Easterbrook, P. and others. The natural history and clinical significance of intermittent viraemia in patients with initial viral suppression to <400 copies/ml. AIDS 16(11):1521-27. July 26, 2002.

Geretti, A. and others. Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. Antiviral Therapy 13(7):927-36. 2008.

Palmer, S. Advances in detection and monitoring of plasma viremia in HIV-infected individuals receiving antiretroviral therapy. Current Opinion in HIV and AIDS 8(2):87-92. March 2013.

Parienti, J. and others. Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One 3(7):e2783. July 30, 2008.

Rosenblum, M. and others. The risk of virologic failure decreases with duration of HIV suppression, at greater than 50% adherence to antiretroviral therapy. PLoS One 4(9):e7196. September 29, 2009.

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