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
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
Hi Tapiwa,
Tenolam-E contains the same drugs as Atripla. So occasionally taking the dose late, or missing one, shouldn’t be a problem. There’s a similar question answered here.
I m living positively and I take medicine tenolam e at 2000hrs every day. Yesterday I missed my dose at took it early in the morning at 0500 hrs, so I’m worried can you assist. Am I going to develop drug resistance
Hi Manuel,
Have you thought about taking the new once daily Raltegravir? This may help with issues of adherence.
There’s no reason why you can’t take one tablet of Raltegravir at the same time as the Kivexa. If you could try this, this would mean that you aren’t having to remember to take meds 3 times a day.
So that there is optimal drug levels of the Raltegravir, you should be taking them a 12hr intervals. Yes, there might be times when this doesn’t happen, but you need to try and make sure that you take your meds are prescribed, This is important when someone is first starting meds.
If timing is an issue, have you thought about setting an alarm on your phone? When you go out, if you think of your meds in terms of your wallet or keys, it could help you to remember them.
Drug resistance is unlikely, but you should be having your viral load checked.
Hi Everyone,
I am currently taking Raltegravir twice a day (at 7 AM and at 7 PM) and Kivexa at 2 PM. My concern is about some delaying in my morning dose, I have been taking it as late as 11 AM, and one day I took both Raltegravir and Kivexa at 2 PM. I know I should be strict with the timing but my delays have to do with sleeping problems I am having and the fact that somedays I spend the night out and forget to carry meds with me. I started treatment 2 months ago and I haven’t missed any dose.
Is there any risk of drug resistance due to this “small” delays?
Thanks beforehand
Hi Anon, this sounds better to check with a doctor.
I have some reaction to cloth which cause some watery pimples on my penis which become small sores once they pop. We are both on ART. We continue to have intercourse even when they pop. Is that wrong?
Hi, if you are both HIV positive, but only one of you is one treatment, there is only aq very low risk. this would be if your partner is already resistance to the drugs you are taking.
How risky is it to have an unprotected sex if my hiv partner not yet on arv’s when my viral load is found undetectable?
Hi Micah,
Ideally meds should be taken at roughly the same time everyday so as to make sure that you always have the right drug levels. However, if you take your meds occasionally later this won’t cause you any problems. Even if you’re out during the party season you could still take them at 10pm.
Hi,
Given the holiday celebrations this month. Can I take my ARV as late as 2 Am? What is the latest yet safest time to take it? I am on Lumivudine/Tenofivir/Efivarenz (one pill) for 4 months now. I usually take it at 10 pm every night.
Thanks!