Question
What happens if I miss TLD for a month?
24 November 2022. Related: Access to treatment, Adherence, All topics, CD4 and viral load, Changing treatment.
Greetings, I live in Cuba, but due to supply problems in the pharmacies there are no ARVs. I will not be able to have TLD medication (dolutegravir/tenofovir/lamivudine) for a month. Until now I was adherent to treatment.
It is a really very stressful situation that keeps me constantly frustrated every day looking for an alternative. There are also no private pharmacies in Cuba where you can buy them, even if they are expensive. We do not have that option in Cuba, we totally depend on them.
I need to know how much it can affect me to spend so much time without taking the medication and if I can’t continue with my same treatment later?
I am afraid because I have heard that dolutegravir is one of the best drugs and if because of this situation I create resistance to this component because I cannot take it as normal, then neither I nor many Cubans on this island will know what we are going to do.
Thank you for reading my words and waiting for your response.
Answer
Hi, how are you doing?
I am sorry to hear about the situation you are in. Do you have any remaining TLD that will be able to last some of this month? Or do you know if you can access a different treatment for this time? e.g., can you be temporarily switched from TLD to TLE for the month?
A month without medication will mean your viral load will be able to increase. After being on treatment for so long, it takes about a week for viral load to become detectable again. You will be able to restart TLD again when it is back in stock at the pharmacies. As you mentioned there is some risk of resistance but this is not definite.
Starting treatment again after a month, will you be able to arrange a viral load test for a few weeks after? You will then be able to check that TLD is working again.
Friends of Caritas Cuba are a local charity to yourself. They have a HIV/AIDS support service that may be able to offer additional support in this instance for emergency access. Have you gone to a hopsital to explain this shortage?
Josh.
Hi Nokuthula, switching between the medications will not be dangerous. Switching will not risk your viral load to rebound.
How long do you need to switch to TEE for?
As the drugs are different you may notice a difference in side effects. What time do you take your current treatment? and unlike TLD, TEE should not be taken with a high fat meal. This will increase how much drug is absorbed by the body and make the side effects worse.
Hi I would like to know if I will be in danger if I switch from TLD to TEE, and switch again from TEE to TLD as at the moment TEE is the only medication I have access to