Question

How strict should I be about the time I take my HIV medication?

13 May 2010. Related: Adherence, All topics, Resistance, Starting treatment.

Hello,

Just to nail down the Atripla window in my mind: my practitioner seems to think it’s very loose – as extreme as 12 hours the odd time being permissible. She certainly dismissed any notion of an anally rigorous dosing.

My personal window therefore is a maximum of 90 minutes – anything randomly between 9.45pm -10.30pm (I have been on it for 5 nights now) but your site seems to suggest a more rigorous timeframe. Should I be aiming for an exact time each dose or is okay to continue with the timeframe mentioned? Should I be picking a time e.g. 10.30pm with a ‘train spotters’ resolution? Or is she indeed correct and as long as I get my nightly ‘hit’ then whether it’s 9.30pm or 11.00pm is immaterial – which is the point she was making.

She also floated the concept for those thriving on Atripla of ‘week days – on; weekends – off’ but I have not come across this concept anywhere else?

Obviously the first part of my long winded question is the most critical, the second an interesting diversion to vaguely wish for.

Thanking you in advance for your time.

Best regards

Paul

Answer

Answer: Charlotte Walker

Thank you for your question.

Once you decide upon the right time for you to take your medication then the closer to this time you take your medication the better. There is a window of about an hour either side of this time for you to take your HIV medication. 12 hours late on occasions will do you no harm but if you are consistently taking your medication this late it is not good. The more frequently you skip doses or take tablets late, the more likely you are to get resistance to the medication.

For further information on the timing of taking your HIV medication please see this similar question. For information on adherence and resistance see these sections in the i-Base ‘Introduction to Combination Therapy’ guide.

To answer your second question, there was a study done called 5-days on 2-days off (FOTO) which looked into intermittent therapy as an option for people already stable on HIV medication.

This study was only with a very small amount of people and so was too small to know the risk of treatment failure or resistance in the long-term. However it was significant that none of the participants had viral load blips or rebounds over a year. The study also did not show any benefit with regards to a reduction in side effects of taking the drugs. The main benefit of FOTO would be financial, as it has the potential to reduce drug costs.

For details of the FOTO study see this link to the study abstract at the IAS 2009 conference,

Cohen C et al. The FOTO study: The 48 week extension to assess durability of the strategy of taking efavirenz, tenofovir and emtricitabine Five days On, Two days Off (FOTO) each week in virologically suppressed patients. IAS 2009, Cape Town. Abstract MOPEB063.
http://library.iasociety.org/AbstractView.aspx?confID=2009&abstractId=3046

C. Cohen