Q and A

Question

How to I manage meds with shift work?

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

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.

32 comments

  1. Roy Trevelion

    Hi Ajey,

    Have you talked to your doctor about feeling very depressed? Side effects of efavirenz can include sleep disturbance (including nightmares), and mood change, including anxiety and depression.

    If you’re taking the single pills called Tenarenz, Telura or Eflaten you can find more about them here. Lamivudine is another name for 3TC.

    But please talk to the doctor about your depression and ask if it’s to do with your HIV meds. If so, there could be other HIV meds that are easier for you to take.

  2. Ajey

    No sir I don’t have any serious side effects but I felt only drowsiness in my working hours…I am very depressed …Tell me what to do i can’t left my job

  3. Roy Trevelion

    Hi Ajey,

    Thanks for letting us know. Do you know your viral load result? And are there any side effects from your meds?

  4. Ajey

    Yes I also took ARV IN DAY TIME DURING MY WORK…MY ARV IS EFAVIRENZ+LAMUDINE+TENOFOVIR.

  5. Roy Trevelion

    Hi Ajey,

    It’s good that your fever is gone. Most people take a week or more to recover from flu. And a CD4 count of 600 is within the normal range for people who are HIV negative.

    However, if you don’t start to feel better please see your doctor.

    How is your HIV treatment going? Please let us know.

  6. Ajey

    Hello I am hiv positive since june 2019 also I am on ARV ,but last Sunday i got cold having throat infection viral flu and running nose…After taking paracetamol my fever is gone but weakness still in my body and having running nose and sore throat what should I do…My cd4 is 600 and can this viral infection effect my cd4 and health

  7. Roy Trevelion

    Hi Ashok,

    What does the doctor say?

    Your HIV meds contain efavirenz. This can cause sleep disturbance, and then tiredness during waking hours.

    But you can talk to the doctor and ask if there are other HIV meds that will be easier for you to take. In the UK, someone working with frequent shift changes 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.

  8. Ashok

    Hello,
    I am HIV POSITIVE I AM WORKING ON SHIFTS,WHILE I TOOK ARV MEDICINE DURING DAY TIME I FEEL VERY LAZY AND SLEEPY.ITS SYMPTOMS IS TEMPERIALY OR PERMENANT.I TOOK TENOFOVIR+EFAFIRENZ+LAMIVUDINE SINGLE PILL.MY WEIGHT IS ALSO DOWN 5 KG.ANY SUGGESTIONS…I NEED YOUR HELP.

  9. Roy Trevelion

    Hi Chandan,

    Thanks for letting us know. You posted this comment on a Q&A about shift work. Efavirenz might not be best for you if you are doing shifts and changing your sleep patterns often.

    If this is a problem you can ask your doctor if there are meds that will be easier for you to take.

  10. Chandan

    TENOFOVIR+EFAVIRENZ+LAMIVUDINE
    My CD4 COUNT IS 636, VIRAL LOAD TEST NOT DONE YET

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