Adherence to HIV treatment

Taking your medication as prescribed is often called ‘adherence’. Adherence to your HIV treatment means:

• Taking all the medication that makes up your HIV treatment combination in the right amounts.
• Taking your medication at the right time, and around the same time each day. For example, you might take it in the morning.
• Following any instructions about food. Some medications need to be taken with food so they are absorbed properly, but others need to be taken on an empty stomach.
• Checking for interactions with other medicines or drugs. This includes any medicines prescribed to you, over-the-counter medicines, herbal and alternative remedies, and recreational drugs.

Does it matter if I miss some doses of my HIV treatment?

The best results of HIV treatment are seen in people who take all, or nearly all, of the doses of their drugs in the right way. Research shows that missing doses is associated with:

• an increase in viral load
• a fall in CD4 cell count
• an increased risk of resistance.

If you usually take your medication at the right time in the right way, it’s less likely to cause a problem if you very occasionally forget to take your medication or take it late.

But if you’ve already missed a lot of doses and something like this happens, things are more likely to go wrong.

What should I do if I miss a dose of my HIV treatment?

You should try to take every dose of your HIV treatment as prescribed. But you might sometimes forget to take a dose, or take it late.

What you should do about a missed dose will depend on the circumstances. If you miss a dose and you’re not sure what to do, ask your clinic for advice.

In most cases, the safest option is to take the missed dose as soon as you realise. After that, you should return to your normal schedule. But if you only realise you have missed a dose close to the time when you need to take your next dose, just take the normal amount. Do not take a double dose to make up for the one you’ve missed.

If you’re sick (vomit) after taking your HIV treatment, you usually don’t need to take another dose. This is because the medication will already have been absorbed into your body. But you might need to take another dose if:

• it’s been less than 2 hours since you took your pills
• you are taking Eviplera or rilpivirine and it’s been less than 4 hours since you took your pills
• you see the pills, or bits of them, in the vomit.

If you’re regularly missing doses of your medication, or taking them late, talk about this with your doctor or other staff at your clinic. They will be able to offer advice and support. In some cases, it may make sense for you to change your treatment to a treatment with a lower risk of resistance.

Ten tips for taking your medication

1. Practise before you start

You might find it helpful to use ‘practice’ doses of sweets or mints before you start your medication. Take these:

• at the same time as you will have to take your medication
• in the same quantities as your medication, for example, if you will be taking three tablets each day, eat three sweets
• while sticking to any food restrictions you’ll need to follow, for example taking them with a meal.

2. Link taking your medication with a daily activity

It may be easier to make a habit of taking your HIV treatment if you combine it with another habit. This could be brushing your teeth, having dinner or going to bed. It might be helpful to keep your medication in a place that helps you remember too. For example, if you’re going to take your medication at the same time as brushing your teeth, keep your tablets near your toothbrush. 

3. Use a pill box

Lots of people find pill boxes useful. These have separate sections which you can put each dose of your medication into.  Especially if you are taking a large number of medicines at different times of the day, a pill box with compartments for the days of the week and times of the day may be useful. You might find it helpful to fill your pill box at the start of the week so you can keep track of what you need to take each day.

Pill boxes might be available for free from your HIV clinic or you can buy one yourself. Check with your pharmacist that all your medications can be stored in a pill box. This is because some pills have to be kept in their original container. For example, the bottle that Truvada comes in contains a small capsule that keeps the tablets dry.

4. Set a reminder on your phone

Some people find that setting an alarm on their mobile phone or watch helps them to remember to take their medication. There are also some phone apps available which will send you a reminder. If you live with someone who knows about your HIV status you could also ask them to help you remember to take your medication.

5. Keep a diary

You could try keeping a diary where you record taking each dose of your medication or use a calendar and tick each day as you take your pills.

6. Have spare doses available

Keep spare doses of your pills in a suitable container in useful places. This might include keeping some in your bag, jacket pocket, at work or college, at a friend’s house, or in your car. This means you’ll have some available if you need them.

It’s important to make sure that your medication is stored out of the reach of children. And remember that medications can go out of date.

7. Plan for nights out

If you’re going out for the night and think there’s a chance you may not go home before your next medication dose, take enough medication with you. Be aware that security staff may not be able to recognise prescription medication and you might be asked about it.

If you’re planning to drink alcohol or take drugs which might affect your memory, try to plan in advance how you might overcome this. This could involve setting an alarm on your phone or telling a friend to remind you when it’s time to take your medication.

If you’re concerned about possible interactions between your HIV medication and recreational drugs, speak to your doctor or another member of your healthcare team. They should be able to offer advice on safely reducing interactions. Do not skip doses. For more information, read Interactions between HIV treatment and recreational drugs.

8. Be prepared when you travel

Going away for a holiday or a work trip can affect your adherence. The change to your routine could mean that you’re away from prompts that usually help you remember to take your medication.

• Even if you don’t usually need phone reminders or pill boxes to help you keep track, you might find them helpful when you travel.
• If you’re travelling to a different time zone you should try and make sure that you take your medication at the same intervals as you normally do. Your clinic staff can give you advice on how to do this. There’s more information on the page Travelling with HIV medications – time zone changes.
• Make sure that you take enough medication with you. Getting more medication might be difficult or even impossible in other countries.
• Take a few extra doses in case you’re delayed.
• Carry some or all of your medication in your hand luggage, as this is less likely to get lost.
• If you’re travelling to another country, take a copy of your prescription or a letter from your doctor explaining that your medication is for a chronic medical condition.
• Keep your medications in their original container with the pharmacy label attached.

If you’re travelling with people who don’t know about your health, plan in advance how you might manage this. For example, having a bottle of water by your bed could give you more privacy to take your medication.

Some countries have entry restrictions for people with HIV. You may be considering stopping your treatment for the time you’re away. This is not recommended; talk to your doctor if you are thinking about doing this.

9. Talk to your doctor 

It's a good idea to talk to your doctor if you’re forgetting to take a lot of doses of your treatment, or if you’re having any other problems with it. Help is available to support you in taking your medication. Or it might be possible to change your treatment so that your medications are easier to take.

If you have questions or concerns about your treatment, your doctor or someone else in your clinic such as a nurse, health adviser or pharmacist, should be happy to talk to you about it.

10. Get peer support

Your doctor may be able to put you in touch with other people living with HIV for support. This might be through peer supporters based in the clinic or through peer support organisations.