Question

Can I stop ART for a few months as my meds were stolen?

4 December 2023. Related: Adherence, All topics, Stopping treatment, Travel.

Hi there

I am on Dovato and I’ve been undetectable since May 2022.

I’m travelling in Peru, however someone stole my bag which had 6 months worth of medicine. I only have one bottle for about 2 weeks and now I don’t know what to do.

It seems like I will have to stop travelling and go home to stay on medication which is really horrible to just think about as I’ve been planning this trip for so long and I can’t go home get the medicine and come back.

How bad would it be to stop the treatment for a month or two, how likely is the resistance after? I’m so worried as I’m very punctual with my medicine. This is why I hate being HIV

Answer

Answer: Simon Collins

Hi there

Thanks for your questions and I am sorry about these complications to your holiday.

Although I can give you general information, you really need to contact your doctor if you can. This is because your individual HIV and treatment history will affect which options are better for you.

Do you have travel insurance that could help? I am assuming probably not as this is difficult to get for a six month trip, If you do though, they might pay to get meds in Peru. The meds might also be a lot less expensive there.

You could google a local HIV organisation or clinic in Peru close to where you are now. It varies between different countries and clinics but someone there might be able to help. For example, they may be able to give you a supply to last you, or they might arrange for you to be able to buy meds.

If you were planning to travel to Brazil, contacting an HIV organisation there might be another option.

Stopping ART is not generally recommended. This is mainly because it is better for your body when your viral load is undetectable. The risks from stopping treatment, if you really need to, will depend on how low your CD4 count went before your started treatment. Also on how high your viral load went.

The results are important because if you stop your meds you viral load would return to the pre-ART level within a few weeks or months. Your CD4 count would also return to the pre-ART level over a few months.

So if you have always had a very high CD4 count, the risk of stopping for a few months will be much less than if you were diagnosed late with a low CD4. This is why you need to contact your doctor to discuss this level of risk. Also because your doctor might be able to send you a prescription to use while away.

If your CD4 count ever dropped below 200, or maybe even below 350, then it is better to find a way to keep on treatment. If your CD4 count never went below 500, it is easier to discuss taking a break if you need to,

However, if you only want to stop for one month or two (rather than six) this might be okay with minimal risk, especially if you can email your doctor for advice.

Your doctor might be able to issue you a couple of months replacement meds – similar to if they were stolen in the UK. I don’t think the clinic could send these to Peru, but a friend might be able to post you them. Different countries have different restrictions about posting meds though, so you would have to find out about this.

Stopping ART also has a small short term risk of seroconversion symptoms, if your viral load rebound very high and very quickly. If you remember feeling ill with really bd flu-like symptoms when you likely became HIV positive, this might happen again.

If you do decide to stop ART, then it might be better to do this now, so you still have an emergency two weeks supply in case you need to restart quickly because of symptoms.

It is great that you have been so careful with your meds up til now. One break in treatment only have a very low risk of drug resistance and your meds are likely to still work just as well when restart treatment again.

Please let me know if you have other questions.

Good luck with whatever you decide.