Question
What is the safe window period to take HIV drugs? How can I help my partner adhere?
16 May 2007. Related: Adherence, All topics, Living with HIV long-term, South Africa.
My partner is on AZT, 3TC and lopinavir/r (Kaletra), but he is often lax in taking his medication on time.
I know that there is only a small window in which to take the medication. I have tried to explain this to him but he feels like i am nagging and tells me to shut up.
I am only concerned because we have small children, i would like him to be there for them. I want to know what i can say to him to make him listen.
I have tried our specialist but my partner lies to them.
What am i to do, how can i help educate him and make him see that i am not nagging i am concerned for his life?
Answer
Thanks for posting your questions and allowing us to post the answer online to help others.
Your first question about the safe window period is something everyone wants to know.
Because different people absorb different levels of different drugs, what may be safe for one person, may not be safe for another. Generally though, a window of about an hour either side should be fine with most drugs, especially once your viral load is already undetectable (less than 50 copies/mL)
This window is different for different drugs, but for Kaletra, AZT and 3TC which should be taken every 12 hours, you wouldn’t want to be late by more than an hour on a regular basis.
Advocates in South Africa talk about the virus as a snake and the treatment as a heavy stone that keeps the snake from escaping. Every time you are late with meds, it is like lifting the stone a bit, and one day this can be enough for the snake to wriggle free. The snake will also be mad – which is like the virus developing resistance to the drugs.
Your partner is very lucky to have you looking out for him in this way – and I can see why this worries you.
Psychologically, taking treatment can be difficult if you think of your life being tied down to a clock. Thinking about treatment in a different way may help.
Living by the ‘clock; is perhaps the wrong focus – what you are trying to do is keeping safe active levels of all three drugs above a minimum level – ie keeping a constant pressure on the virus – or a heavy enough stone on the snake.
Your husband is taking the treatments and has to feel he has the space to decide all this for himself. There may be easier options like a once-daily combination and a discussion with his doctor may include these options. It would also be important to try and find out why he is having trouble.
This may be that he doesn’t understand the way the drugs work or that they now offer a real chance to live a long natural life. He may link medication with unresolved issues about his HIV-positive diagnosis or any number of other things in life. It is very unlikely that he is doing this deliberately but the earlier it could be addressed the better.
Everyone is different. Sometimes, even though this is a depressing aspect, some people need to fail treatment and be shocked into taking treatment more seriously.
Having the space to talk about this without linking it to adherence at first may help, but also may take some time.
It may also be useful for you to be able to talk to a health advisor or counsellor for support, or in case they have other ideas.
Good luck in trying many different approaches.
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