Continuing Treatment: Making It Work Long-Term

Regardless of the particular drugs you choose for your cocktail, there is one important rule to remember: Your drugs will only work when you take them. Duh, you say, but remembering to take your pills at the right times every day isn't always easy. And sticking to the pill-taking schedule (also known as adhering or complying) is very important because these drugs get broken down and removed from the blood very quickly. The pill-popping schedule makes sure that the amount of the drug in your blood stays above the level required to suppress the virus. Missing even one dose means the drug levels can drop too low to control the virus. HIV replicates rapidly, and low drug levels can allow it to make many thousands of copies that will go on to infect new cells. Even more important, those low drug levels can allow for the development of drug resistance. In order to get the most out of your cocktail -- and avoid drug resistance -- you must take all of your pills as scheduled and directed. Even missing a dose or two per week could sabotage your long-term success in using these drugs.

Your doctor and pharmacist may have practical tips to help improve your adherence to your regimen, so be sure to discuss this with them before starting your pills. Here are possibilities that some have found useful:

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• Many doctors and pharmacists recommend practicing with candy (Smarties or jellybeans) or mints for a couple of weeks before starting the real drug cocktail. Choose one practice pill for each drug you'll be taking and follow the schedule you'll need for the real drugs.

• Before starting a new regimen, consider all aspects of what it will require in order to ensure that it fits your lifestyle.

• Divide your pills into appropriate doses for each day (and each time of day) at the beginning of the week. Use plastic pill boxes (sometimes called "dosettes") with separate compartments for storing the pills. Or use small plastic baggies that can be marked for this. This advance preparation can save time opening multiple bottles every day and ensure that there's a pre-prepared dose ready to take with you any time you're in a rush to leave the house.

• Wear a watch with an alarm or carry a small medication "beeper" (talk to your pharmacist about getting one) to remind you when to take your next dose.

• Keep your medications where you can clearly see them -- in the bathroom, near your bed, near the TV, or any other place that you will be likely to see them and remember to take them on time.

• Keep a supply of medication at places you frequently visit -- family or friend's house, work, a clinic, etc. Ask your nurse or pharmacist for directions on how to store your pills -- some may need to be refrigerated. Be sure to check the expiry date on the bottles from time to time.

If all the tricks in the world don't keep you on schedule with the drugs in your current cocktail, you may need to consider changing it. In order to choose a new regimen that may work better, it will be very important for you to honestly consider what kept you from sticking to your current approach. For example, if you were supposed to take your drugs three times a day but found that your busy mid-day schedule meant that you would often miss your second dose, you might want to consider switching to a simpler, once- or twice-a-day regimen (see discussion in "A kinder, simpler regimen: once-daily therapy"). If the fact that you often experienced smelly gas or diarrhea or any other side effect that you found particularly problematic after taking a particular drug caused you to skip doses when you were going to a meeting or out on a date, you might want to consider substituting a drug less likely to cause that problem.

Before you use up more drug options by switching at the first sign of side effects, do consider all the possibilities for eliminating the problematic symptoms discussed in CATIE's Practical Guide to HIV Drug Side Effects.