Question

How to I manage meds with shift work?

24 December 2017. Related: Adherence, All topics, Changing treatment, Southern Africa.

Hi. I started meds (ARVs) not long ago. I take it every night at 20:00.

The problem is that I’m working as a security officer in South Africa. I work 3 days, 3 nights and I go off 3 days. My problem is time balancing since the meds are making me feel dizzy.

Last night was my first night at work since I started meds. So I forgot to take meds with me to work, remembered that I was suppose to take it at 20:00, then I discovered that I forgot it. I knocked off duty in the morning and went home. I made sure that before I sleep as I’m coming from night shift I take my meds at 08:00.

Did I do a right thing, if not what should I do?

Answer

Answer: Simon Collins

Hi

Thanks for your question which affects a lot of people.

Although you didn’t say the name of your meds, the side effects and timing make this sound like efavirenz.

One of the most widely use single-pill combinations is based on efavirenz, usually with tenofovir DF and emtricitabine in the same pill. The first brand name was called Atripla but there are lots of generic versions.

In the UK, someone working with frequent shift changed would use a different HIV combination. So one thing is to please speak to your doctor to see if there is a choice. Explain how difficult this is to work shifts and say you need a different medicine.

Depending on where your clinic is in South Africa, this might be easy or difficult. Even if it is difficult now (ie to change to a protease inhibitor), in the near future, a combination that is based on a drug called dolutegravir will be easier to use. This is because this will be a similar price to efavirenz and health systems will make this easier to get.

In practice, you did the right thing in taking your meds once you got home,

If your viral load is undetectable now, then you can have a little flexibility with your dose. This is because all three meds stay in your body for longer than 24 hours.

For now, until you can see your doctor, change your dosing to always taking your meds before you sleep. When you alternate shifts, it will be okay to take the meds either earlier or later than 24 hours since the previous dose.

Because of side effects, it will probably be better to extend the time between the new shift dose rather than bringing it forward earlier. This will be much better than trying to work when you are getting side effects form taking an evening dose when working a night shift.

Better if you could change to an easier combination though.