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Your medication and adherence
You are most likely to take your HIV therapy when it fits in with your existing lifestyle, and decisions about your treatments should be made on an individual basis, taking account of your circumstances. This should include not only a history of your past treatment experiences, but also your needs and preferences about how often you take your medication, the chances of getting side-effects, and the potential for harmful interactions with other medications.
Looking at your lifestyle needs before you start treatment may mean that you are less likely to encounter adherence problems later on.
Late doses
Taking your medication late can be as bad as not taking it at all, allowing HIV to become resistant to some or all of the drugs you are taking.
The safest approach is to aim to take all your doses at the right time and in the right way, but most people will probably take their medicines late at some time. If this happens very occasionally it will probably make no difference to the success of your medication, however if you regularly take your medication very late, then it could allow HIV to become resistant to your medication.
Some anti-HIV drugs, particularly protease inhibitors, are processed more quickly by the body than others, meaning that it is very important to take them at the correct time as the amount of drug in your body will not be sufficient to suppress HIV. This is called a drug's "half life."
For some other drugs (nucleoside analogues, the non-nucleoside analogues efavirenz (Sustiva™) and nevirapine (Viramune™) and the nucleotide analogue tenofovir (Viread™), it may be possible to take your drugs an hour or two late (or early) and for it to have minimal risk for the success of your medication.
However, for other drugs it is very important to stick as closely as possible to exact prescribing times. The drugs which are most likely to require strict dosing times are protease inhibitors, particularly indinavir (Crixivan™), saquinavir (Fortovase™) and nelfinavir (Viracept™), which are not boosted by the addition of small doses of ritonavir (Norvir™).
Do not assume that because somebody else is able to take their medication late, even if they are taking the same drugs as you, that you will be able to do the same, as the speed and effectiveness with which people process medicines can vary considerably.
If the way you lead your life means that you find it difficult to stick to very strict dosing schedules then talk to your doctor about the possibility of switching to a combination that requires less rigorous timing.
Going out, travelling, or doing anything which interrupts your normal routine may cause you to have difficulty taking your medication at the correct time. If you know that your normal dosing routine may be interrupted, then try to make a plan that ensures that you take your medication as close as possible to the correct time. For example, taking your pills with you, having a bottle of water to hand, and if you need to take your medicine with food, having a bar of chocolate or some other easy to carry and eat food, may mean that you are able to take your medicines without disrupting either what you are doing or your medication routine.
Asking people to remind you to take your medication, if you are socialising and the people you are with know you have to take doses of drugs, may also prove useful. Also, keeping spare doses of medicine in places where you may be when you have to take your medicines, such as work, at friends' or relatives' homes, or in your bag may also prove useful. Remember though, always store medicines out of the reach of children.
Dosing frequency
Combinations taken three or more times a day are more difficult to adhere to than combinations taken less frequently. In addition, taking three doses a day may be more difficult if you are working, as you would be required to take a midday dose, and this might be difficult to remember. It is now possible to construct a combination that needs no more than two doses a day from all the three main classes of anti-HIV drugs. Once daily dosing is also becoming available.
Dosing requirements may also affect your ability to adhere, particularly if you need to take medication with or without food. You may wish to consider this if you have a preference.
If you forget to take a dose of pills, then take them as soon as you remember and carry on with your normal dosing schedule. However, you should not take a double dose to make up for a missed dose if you forget a dose completely. Consider talking to your doctor about how flexible the dosing schedule for your regimen is. Some drugs are cleared from the body more slowly than others meaning that it may be possible to take a dose an hour or two late, however for others it is imposrtant to take them at very regular intervals.
Number of pills
This is often referred to as 'pill burden'. Some people find taking a large number of pills difficult to manage. If you have a choice, it’s probably best to opt for the simplest combination available to you.
However, many people still experience very real problems with adherence even when they are taking HAART regimens which are meant to be simple and include fewer doses or pills. As mentioned, even supposedly easy-to-take HAART regimens have to fit in with the day-to-day realities of living with HIV and taking medication. If you are having problems taking any HAART regimen, then tell your doctor or other member of your health care team.
Interactions and side-effects
Side-effects are one of the most common reasons for people missing doses. Certain side-effects and interactions are more likely to occur with some regimens and particular drugs. Side-effects can also have practical problems, as they might cause you to vomit or feel sick and so miss doses, or they might make you tired so you sleep through the time when you should take your dose.
Some anti-HIV drugs can also interact with medicines prescribed to treat other conditions or with recreational drugs. It is important to tell your doctor what other drugs or supplements you are taking. Most HIV specialists are comfortable discussing recreational drug use and at helping people to find treatments which are safer to use with them.