Adherence: Keeping up with your meds

May 2008     View PDF     En español

Things to consider before you start therapy

Taking on complex, long-term treatment doesn’t feel natural to most people. However, this challenge is not unique to people with HIV. Millions have learned to cope with diseases that require long-term management, including diabetes, mental illness and heart disease, among others.

Whether or not you feel you’re able to adhere to a new regimen may be one thing to consider — along with your lab results and overall general health — in deciding the right time to begin HIV therapy. Your readiness, or ability to commit to the demands of therapy, is an impor­tant consideration to discuss with your doctor.

Why adhering to all your HIV drugs is important is because not taking them as prescribed every day will lead to inadequate levels of the drugs in your blood. This can result in many things, including no real therapeutic benefit, possible disease progression, development of resistance, and unnecessary side effects.

Giving careful thought to what benefits you hope to get from treat­ment, how you’ll evaluate the benefit, and how you might manage side effects will be helpful. Some people try a “dry run” before beginning therapy, like taking empty gel caps, or small candies like M&Ms, on the prescribed schedule while sticking to any diet requirements. While this doesn’t prepare one for possible side effects, it can help you find times when remembering to take therapy might be more of a challenge

Perhaps the first and most important aspect of adher­ence lies in choosing the right therapy for you in the first place. Drugs can differ in many ways including:

• Whether or not they can be taken with food,
• Whether they are taken by mouth or injection,
• How many times a day they must be taken,
• How many pills per day are needed,
• What other drugs or complementary therapies they can and cannot be used with,
• Their side effects and how they make a person feel, and
• Some require refrigeration or other special handling.

Adherence is more than just taking pills. Properly adhering to your medicines involves sticking to an entire regimen: taking the full dose as prescribed, taking your pills at the prescribed times every time, obeying any food restrictions, and obeying interactions with other medicines, herbs and supplements.

 

Similarly, people differ widely in their habits and needs. A few examples:

• Some people are bound to rigid work schedules, such as hourly workers.
• Some have constantly changing schedules, or they routinely move in and out of different time zones, like airline workers or truck drivers.
• Some people are unable to work and their schedules are dictated by a seemingly endless string of medical appointments.
• Some also have children, parents or partners to care for.
• Some have people around to help remind them of their drug schedules, while others are alone and must rely on timers, pill boxes or other devices.
• Some people have wasting syndrome or infections that might make eating difficult; others have no dietary problems but don’t eat regularly.
• Finally, some people have to deal with other challenges like substance abuse, homelessness or mental illness.

To find a treatment regimen you can live with, it’s necessary to settle two sets of requirements: yours and the drug’s. People who lead busy but largely unstructured lives might prefer drugs that can be taken easily with or without food. This may make it easier to fit therapy into changing routines. Others, whose time is tightly structured by work, might find it easier to go on more demanding regimens. These people can select a regimen purely on the basis of its potency.

People who have trouble eating or who struggle with weight loss may wish to avoid drugs that can’t be taken with foods or even conversely, those requiring that they be taken with food. Others who take many other drugs for opportunistic infections or other health conditions might avoid HIV drugs that have many drug inter­actions. They might even avoid creating regimens that require taking many more pills. Also, the more HIV drugs you’ve already used, often the fewer choices you have about what to use next. Thus, often in more advanced disease, your drug history tends to dictate what can and can’t be taken.

There may not be any perfect regimen for you, but there are options that are more and less easy to adapt to your life. The goal is to select a regimen you can live with — one that fits with who you are and how you live. Once you select a regimen, sticking to it requires planning, support and commitment.

One study suggests that about 12% of people miss one dose in the past day, and 11% the day before that. Other studies report that nearly all who failed to achieve and sustain a viral load below the limit of detection had greatly changed from their prescribed regimens for a month or more.   There are many reasons for failing to stay on your treatment regimen. One study showed that of those who missed one or more doses:      40% simply forgot      37% slept through a dose      34% were away from home      27% changed their therapy routine      22% were busy      13% were sick      10% experienced side effects      9% were depressed

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