Starting Antiretroviral Treatment For Hiv
FAST FACTS
- Antiretroviral treatment keeps HIV under control, protecting your immune system so that you can stay healthy and live a long life.
- People living with HIV are advised to start treatment straight away, but some people may need time to process their diagnosis before they feel ready.
- There are lots of different antiretroviral drug combinations. Your healthcare worker will help you find the right one for you.
Its normal to have lots of questions before starting HIV treatment. Your healthcare workers are there to talk to you about any concerns you have and answer your questions. The information on this page should help you to think through what you need to know and the questions youd like to ask.
I Missed A Dose Of My Hiv Meds Should I Take A Double Dose Next Time
Stuart D. Federman, PharmD, AAHIVP Gateway Apothecary Saint Louis, MO
You do not want to double your dose. The way the drugs are metabolized , taking a larger dose will not make up for a missed dose. If the medication is a once daily medication and you remember that you missed the dose within an eight to 10 hour window after your missed dose, most medications can be taken when remembered and the next dose should be taken at the regularly scheduled time. If it is past 10 hours, skip the dose that was missed and take your normal dose at the next scheduled time. It is estimated that you need to have an adherence rate of 95 percent or higher to prevent HIV becoming resistant to the medication over time. There is nothing worse than taking medications sporadically and allowing the virus to be exposed to low levels of the drugs in the body, which will lead to resistance to the medications. When initiating or changing regimens, ask your doctor or pharmacist what you should do if you do miss your dose since all medications are different. Additional writing by Amanda Wong, student pharmacist at the St. Louis College of Pharmacy.
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What Is Hiv Drug Resistance
HIV medications work by preventing the virus from replicating . When a particular strain of HIV is able to make copies of itself, even in the presence of a particular antiretroviral, we say that it is drug resistant.
HIV drug resistance isnt a blanket condition. People living with HIV may have one or more drug-resistant mutations that make them less sensitive to one or more antiretrovirals. For example, if people have protease mutations, their HIV is resistant to protease inhibitors, meaning that a drug like darunavir , a protease inhibitor, may not work for them. People with reverse transcriptase mutations may be resistant to a drug like emtricitabine/TDF , a nucleoside reverse transcriptase inhibitor.
Because antiretrovirals in the same class prevent HIV from replicating in the same way, if the virus becomes resistant to one drug within that class, it can become partially- or fully-resistant to all drugs within that class. For example, a person that develops HIV drug resistance to Prezista may also be resistant to atazanavir , because they are both protease inhibitors.
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I’ve Missed A Dose What Should I Do
Prescriber Update 24: 14May 2003
Andrew Gilbert, Libby Roughead and Lloyd Sansom, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide
Reprinted from Australian Prescriber 2002 25:16-18 with permission.
More than 80% of patients occasionally miss a dose of their medication. Health practitioners ought to plan with their patients what to do if a dose is missed. Patients believe that this plan should be a required part of the information received when a medication is prescribed and dispensed. Consumer Medicine Information sheets, which are available for most commonly prescribed medications, contain a section on what to do if a dose is missed. The routine use of these sheets or similar advice may help patients to know what to do when they miss a dose.
You Missed A Dosenow What
Again, it depends on the medication youre on. But Danielle Berger, PharmD, a pharmacist who manages a Walgreens store in Charlotte, NC, recommends this general rule of thumb: If its only been a few hours since your missed dose, go ahead and take it then, pop your next pill as usual. If its been more than a few hours, hold off and take your next dose on schedule.
If its only been a few hours since your missed dose, go ahead and take it.
For example, say you need to pop a pill twice a day, once at 8 a.m. and again at 8 p.m. If you realize you missed the morning dose at 11 a.m., go ahead and take it. But if you realize you missed it late in the day , skip itjust take your 8 p.m. dose as usual. Now youre back on track! Feel like your Rx might be an exception to this rule? Play it safe and contact your pharmacist.
Walgreens makes it easy to get in touch: You can either call your local store, or use their Pharmacy Chat* feature to connect with a pharmacist online, 24/7. Even if the store is closed, you can go on our app and chat with pharmacists, Berger notes.
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Do You Have To Take Your Hiv Medicine If Your Viral Load Is Undetectable
Yes. ART is not a cure and the virus remains in your body, even if your viral load is undetectable. So you need to keep taking your HIV medicine as prescribed. If you stop taking your HIV medicine, your viral load will quickly go back up.
If you have stopped taking your HIV medicine, talk to your health care provider as soon as possible. Your provider can help you get back on track and discuss the best strategies to prevent transmitting HIV to your sexual partners until your viral load is confirmed to be undetectable again.
I Cant Cope With These Side Effects What Can I Do
You must keep taking your treatment until youve spoken to a medical professional. This is because, if you stop, it risks HIV becoming resistant to the drugs which could mean the drugs dont work for you anymore.
If a side effect doesnt go away and is affecting your quality of life, your healthcare provider may recommend that youswitch drugs.
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What If Youre Missing Doses Of Prep Regularly
If you find yourself missing doses frequently, it may be worth looking at why its happening. People should recognise that their lives get busy and that they cant always rely on themselves to remember every time. says Dr Wright. There are a lot of things you can use to help remind yourself when your next dose is due. Something as simple as setting an alert on your phone can be a big help.
Easy tips to help you remember to take your meds! | Emen8
There are also a number of apps specifically designed for PrEP users, which contain detailed information about PrEP, along with scheduling help for all three regimes one popular example is My PrEP .
Theres no one-size-fits-all solution and peoples circumstances change you may find that adhering to a PrEP regime isnt something that works for you, for any number of reasons. If you find that you are missing doses regularly, take some time for deeper reflection on why its happening, and whether the regime of PrEP youre taking is the best choice for you, says Dr Wright. For example, if youre not having much sex at all and youre missing lots of doses of your daily PrEP, you could talk to your doctor about switching to on-demand PrEP. Or alternatively, if you frequently forget doses of on-demand PrEP and youre having sex pretty often then maybe daily PrEP is a better choice for you. In the future, maybe injectable PrEP, which is given every eight weeks, will be the best choice for you.
Will I Get Drug Resistance If I Miss A Dose
In general, if you forget to take a dose, take your medications as soon as you realize youve missed the dose. However, if its almost time for your next dose, just wait until your next dose and continue your regular routine. Most important, do not take a double dose you cannot make up for a missed dose that way. Although its important to take your HIV medications every day, you likely will not develop drug resistance from missing just one medication dose.
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Look For A Treatment Plan That Supports You
Finding the right treatment plan with your healthcare provider is one of the most empowering steps you can take.
Taking your medication every day as prescribed helps control your HIV and may prevent the development of AIDS. Whether you were just diagnosed or youve been living with HIV, it takes support to start a treatment and stick with it.
Pair It With Another Daily Habit
Put your morning medication that should be taken with food next to the cereal container. Or place nighttime pills by your p.m. face cream. Taking meds when you do other daily tasks will help you remember, says the American Health Association.
3. Use a pillbox.
Simple yet effectiveget one printed with the days of the week, Berger recommends. Load it up once a week with all your medications, so youll always be able to track if you took the days dose.
*Pharmacy Chat: Pharmacy chat is not intended for use in medical emergencies. If you are in need of immediate medical attention, contact your physician, poison control center or emergency medical professional. If you need to speak with a pharmacist for urgent matters, contact your local Walgreens pharmacist. The information provided is not a substitute for medical advice from your physician. Only available in English.
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What Should You Do If Youve Missed A Dose Of Prep
First of all, it depends on how youre taking PrEP.
The most common way that PrEP is used in Australia is in the form of daily PrEP, says Dr Wright. It involves taking one pill containing two antiviral drugs tenofovir and emtricitabine at the same time every day, and this provides highly effective protection from HIV.
What happens if you miss a dose of daily PrEP?
Its important for people to know that having it a few hours late is not a big deal. For daily PrEP, it doesnt have to be exactly 24 hours between doses, explains Dr Wright. If you realise youre late taking your dose, just take the pill as soon as you can and then resume your regular PrEP routine the following day.
And what if you miss a dose completely?
Also no cause for concern, says Dr Wright. Missing a dose here or there wont significantly impact the amount of protection you are getting. Theres no need to panic or double dose the next day. Just keep taking your normal dose at the normal time moving forward.
100 per cent adherence to any ongoing medication regime is rare,
What happens if you miss a dose of periodic PrEP?
The same principle applies for periodic PrEP, which is similar to daily PrEP, but over a finite period of time. Taking your pill at the same time every day is best, but youre still protected if youre out by a few hours, or if you accidentally miss a day.
What Will Happen If I Skip My Arv For One Day
Missed HIV medication doses can limit their usefulness and raise the risk of developing drug resistance, which causes certain HIV medications to lose their potency. If you find you’ve missed a dosage, take it as soon as you can, then take the following dose at your regularly scheduled time. Continue taking all of your medications as directed by your doctor.
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What Else Do I Need To Know About Taking Hiv/aids Medicines
It’s important to take your medicines every day, according to the instructions from your health care provider. If you miss doses or don’t follow a regular schedule, your treatment may not work, and the HIV virus may become resistant to the medicines.
HIV medicines can cause side effects. Most of these side effects are manageable, but a few can be serious. Tell your health care provider about any side effects that you are having. Don’t stop taking your medicine without first talking to your provider. He or she may give you tips on how to deal with the side effects. In some cases, your provider may decide to change your medicines.
What About For People Who Have Multi
Fortunately, multi-drug resistance is uncommon, said Wohl. And even in these folks, some meds may work, he said. Resistance is not always all or nothing. That means the resistant virus may still be affected by a med, just not as much. Combining meds with partial activity can work. Also, new drugs are still coming out that can work against drug-resistant strains.
The situation for patients with multi-drug resistance depends a lot on just how many drugs that the virus is resistant to, explained Young. For most people, the careful use of drug resistance tests can help sort out what medications the virus retains sensitivity to. If a regimen can be constructed with two or more active drugs, then viral suppression is likelythough adherence to the next round of treatment is perhaps even more critical than before.
But what about some of the worst-case scenarios? Is there still hope if you exhaust most or all of the treatment options?
For patients with only one, or no active drugs on the resistance tests, the situation is more serious. For these individuals, well consider how drugs still in clinical trials may work. Indeed, several new classes of medications may still suppress the virus, said Young.
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So Why Is It So Important To Take My Medication Every Day
When the HIV virus infects your body, the virus makes copies of itself. HIV medicines can help stop HIV from making copies of itself and can reduce the total amount of HIV in your body. But if you do not take HIV medicines every day, they may eventually stop working against HIV. This is due to the HIV virus acquiring drug resistance.
Once you become resistant to an HIV medicine, you will have to switch to another one. Taking all your HIV medicines daily is the key to keeping your HIV levels down and avoiding resistance. When you stick to your HIV medicine schedule very closely, it is called adherence.
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Assessing The Importance Of A Missed Dose
The severity of the patient’s condition, whether clinically significant breakthrough effects are likely to be observed, and the characteristics of the medication should be considered when deciding the most appropriate strategy following a missed dose. Vulnerable patients are easily recognisable in any practice and include those on medications of low therapeutic index,bor suffering from conditions which require constant maintenance of therapeutic concentrations . On the other hand, for most people with hypertension or hypercholesterolaemia a single missed dose will be of little consequence.
The patients should be informed at the time of prescribing and dispensing, of strategies to minimise missed doses and to redeem the situation when a dose is missed. Highlighting the strategy as it appears on the CMI or writing out an action plan as a reminder to the patient may prove very useful.
While a pre-emptive approach is ideal it is recognised that requests for information about missed doses are common. Knowledge of a drug’s half-life, a major determinant of the fluctuation in interdose concentrations at steady state, is useful for making recommendations on what to do if a dose is missed. Upon cessation of therapy, it takes four to five half-lives for the drug to be completely eliminated.
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What If I Forget To Take My Pills
While you should try to take every dose of your medication as prescribed, most people taking HIV treatment occasionally forget to take a dose or take it late. But there is a difference between an occasional missed dose and regularly forgetting on a daily or weekly basis.
In general, if you forget to take a dose, take your medications as soon as you realize youve missed the dose. However, if its almost time for your next dose, just wait until your next dose and continue your regular routine. Most important, do not take a double dose you cannot make up for a missed dose that way. Although its important to take your HIV medications every day, you likely will not develop drug resistance from missing just one medication dose.
If you miss a dose and are not sure what to do, its a good idea to ring your clinic for advice.
What If I Miss Multiple Doses
Now, the level of effectiveness becomes a much bigger issue if you skip several days in a row or you take PrEP inconsistently. As mentioned before, patients who took PrEP only two to four times a week were at a higher risk of HIV transmission than patients who took PrEP daily.
Therefore, the chances of HIV transmission could be greater if you miss multiple dosages of PrEP particularly if it is within the first week to twenty-one days of taking it.
It is highly recommended that you reach out to your doctor to let them know how many dosages you have missed especially if you have engaged in behavior that could put you at risk of HIV contraction.
The leading causes of HIV transmission include:
- Having unprotected sexual intercourse with a partner who is HIV positive or whose HIV status is unknown.
- Sharing intravenous needles with others.
It is incredibly important that you are honest and upfront with your doctor regarding the number of doses you have missed so they can determine the next steps for your PrEP regimen. Your doctor might order additional tests to be sure you are HIV-negative before having you continue with PrEP.
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