Question
Can I split tablets to make my meds last longer? – until the President crisis is over?
1 March 2025. Related: Access to treatment, Adherence, All topics.
My viral load reads below 20 for the past 2 years.
I’m concerned because we are now not going to have medication due to friction between 2 presidents.
In order to save my meds til this dilemma is sorted can I take half a tablet every second day or is this risky?
Answer
Hi there,
No, no, no – please do NOT try to split HIV pills – this is very risky.
This is a risky because a half dose will not be strong enough. Also, each of the drugs in the combination might not be evenly distributed in the pill.
However, because you are undetectable, there might be a way to make your meds last longer.
If you are taking a single pill with three meds – either TLD or TLE – then you might be able to save two pills every week. This is because the FOTO studies (Five-On, Two-Off) showed that taking five pills every week kept viral load undetectable.
Please see this Q&A for more details.
https://i-base.info/qa/25807
Please also talk to your doctor about this first.
TLD = tenofovir + lamivudine + dolutegravir.
TLE = tenofovir + lamivudine + efavirenz.
Also, thank you for posting about your situation. I am really sorry that you are in this situation. Many people are working hard to make sure HIV treatment continues to be available.
Which country are you in?
Dear Jacques, thank you for your comment.
It sounds like you have just been very lucky so far.
In the study you link to, 18 out of the 94 people in this study had viral load rebound. This was in a research setting. These participants needed close viral load monitoring for this to be detected early. Other criteria in most studies include someone being on their first combination, having had undetectable viral load for a certain time and not having hepatitis B.
Most of us only get viral laod testing once or twice a year. This would let viral rebound to easily develop extensive drug resistance.
Whether this works will depend on which drugs are being used and the individual drug levels someone gets. Nearly every drug will have high levels in some people and low levels in others. So maybe you are lucky and have good drug levels but someone with lower levels would not be as lucky.
The strongest evidence from reduced dosing uses Five-On Two-Off (FOTO) where people take ART on weekdays but not on the weekends. These studies used meds that stay in the body longer. The first studies used TLE and more recent studies include an integrase inhibitor.
The research is interesting though and French guidelines allow people in some circumstances to only take ART on 4 or 5 days every week. The guidelines also have strict criteria too. For example, being on the first ART, with no drug resistance and no hepatitis B etc and never having a low CD4 count. This is supported by a French study called QUATUOR:
https://pubmed.ncbi.nlm.nih.gov/35120640/
This study was based on the study that you quoted by Jacques Leibowitch. This doctor was a very distinguished French HIV researcher and scientist who also contributed to first identifying HIV in the early 1980s.
The recent CROI conference in March 2025 also included this study of reduced dosing with Biktarvy.
https://i-base.info/htb/50597
The conclusions includes that more research is needed before this could be widely recommended. A larger study called BREATHER-PLUS that uses FOTO dosing should be reporting results in a couple of months and these will be important too.
Hello, I live in the West and have been stocking up on my medication for two years after reading several studies that reported taken that four doses a week are sufficient. For the past two years, I’ve been following a 4/7 regimen.
One study from 2015 – called ICCARRE regimen – involved 94 people taking antiviral HIV medication four days a week or less instead of daily meds (https://pubmed.ncbi.nlm.nih.gov/25833895/).
The program was developed by Jacques Leibowitch and involves everyone starting out taking meds seven days every week and then cutting down.
In the study, cell-activation markers and cell-bound HIV DNA levels remained stable or declined. CD4/CD8 ratios rose to ≥1 in 35% of patients. CD4 counts went ≥500/µl in 75% of patients.
Modern antiretroviral therapy medications might be even better because they have get to better levels in your body and are more forgiving of missed doses than before. The best thing is not to skip more than three consecutive days. That means you could take it from Monday to Thursday, or Monday, Tuesday, Thursday, and Friday, as it feels safer.