Early Doses, Late Doses, Extra Doses, Missed Doses: What's the Risk? An HIV Doc Responds

Executive Editor
Joel Gallant, M.D., M.P.H.
Joel Gallant, M.D., M.P.H.

Adherence imperfection is one of the more common concerns TheBody.com hears about from people taking once-daily HIV treatment regimens. They want to know: What's the penalty of a missed HIV medication dose? How much room is there for error if a person is off by an hour, or three hours, or an entire day? When it comes to meds, how human can a person get away with being?

On his personal Tumblr, Joel Gallant, M.D., M.P.H., a renowned HIV physician at Southwest CARE Center in Santa Fe, New Mexico, answers questions from people living with HIV on a number of issues, including concerns related to treatment adherence and missed doses.

In the past month alone, Gallant has answered several such questions from people taking once-a-day HIV drugs. His answers tend to be as brief as they are encouraging. For instance, when one person asked:

I know it's not a problem if I take my meds two to three hours later. However, what happens if I take them two to three hours earlier (so there's only 21 hours between doses)? For example, after a weekend when I wake up later or when I'm traveling through several time zones.

Gallant replied:

By definition, taking your meds two to three hours late means you will end up taking them two to three hours early. If you normally take your meds at 8:00 a.m., but one day take them at 11:00 a.m. (a 27-hour gap), getting back on schedule the next day will mean taking them with a 21-hour gap. It's not a problem!

When another person asked:

I take my Triumeq [abacavir/dolutegravir/lamivudine] in the morning after breakfast before going to work. As yesterday was a rush morning, I might have taken two pills (one during the breakfast and another one before I stepped out of the house). This morning, I took one pill as usual. Do I have to skip one dose? Or must I go on as usual with one pill per day?

Gallant answered:

You've already resumed normal dosing, so there's no need to skip a dose now. If you buy a pillbox, you'll never have to wonder whether you took a dose or skipped it.

And when a person asked:

I take Atripla [efavirenz/tenofovir/FTC] daily at 11:30 p.m. Soon, I am going to start working at 5 a.m., and I am thinking about taking the pill at 9 p.m. Is there any risk of acquiring resistance to Atripla or losing [the drug's] effect because of this abrupt change of time when I take the pill? Another question: When I go out on Saturday nights, I take the medicine at 3 a.m. Is that very wrong?

Gallant responded simply:

No risk. Take it every day. It doesn't matter when.

These answers, along with the many that are regularly posted by Ben Young, M.D., Ph.D., on our "Ask the Experts" Forum on Choosing Your HIV Meds, paint an encouraging picture for people on HIV treatment today: The drugs we now have available are so effective, and their HIV-fighting effects are so long-lasting, that they're far more forgiving of a missed dose than commonly used HIV medications were 20, 10 or even five years ago. While excellent adherence is certainly worth striving for, experts say that you can still maintain full control of HIV with only very good adherence.

The questions and answers have been lightly edited for clarity and grammar.

Joel Gallant, M.D., M.P.H., is the associate medical director of specialty services at Southwest CARE Center in New Mexico. You can ask him a question directly on his Tumblr page, Ask Dr. Joel.

Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.