Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects
two days without pils
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testii28:
I just started my therapy last month. The vacations were extended in the country where I live. There are only two pharmacies where I can get my medicine and they are closed. I am running out of pills for 2 days. I have read a lot about resistance. I am a bit scared that this can destroy my therapy.
Jim Allen:
Hiya,
Missing two days within the first month of treatment isn't ideal, however, resistance should not be an issue.
Ideally, we should aim to take our meds 100% of the time, but life doesn't always work out that way. You could try in the months/year ahead, to get your prescription filled one or two days early each time so that you build up a reserve. That way holidays or last-moment situations don't result in treatment interruptions.
Best, Jim.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943894/ Adherence and virologic outcomes among treatment-naïve veteran patients with human immunodeficiency virus type 1 infection
A cohort study was conducted on HIV veterans initiating antiretroviral therapies in 1999 to 2015
In summary, this study showed how initial adherence differently influenced the viral suppression rate across different regimens. No evidence shows 95% adherence threshold is necessary. Patients with medium adherence (75%–<95%) can achieve viral suppression with the rate not statistically significantly different from patients with high adherence.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/ Adherence to Antiretroviral Therapy and Virologic Failure
Paterson et al suggested that at least 95% adherence to unboosted PIs was required for virologic suppression. This 95% adherence cut-off point, based on what is now obsolete therapy, has been widely used as the level of optimal adherence needed to be met by patients taking newer agents and their combinations.
This meta-analysis synthesized 43 studies (27,905 participants) performed across >26 countries, to determine the relationship between cut-off point for optimal adherence to ART and virologic outcomes.
Irrespective of the cut-off point for optimal adherence, our findings support the tenet that optimal adherence to ART is associated with positive clinical outcomes. The threshold for optimal adherence to achieve better virologic outcomes appears to be wider than the commonly used cut-off point (≥95% adherence). Though patients taking ART should be instructed to attain ≥95% adherence, apprehensions of slightly lower adherence should not deter prescribing ART regimens at an early stage of HIV infection.
Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data
A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression.
Results: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively.
Conclusions: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.
testii28:
Thanks Jim, all the information are sometimes overwhelming.It scares me and gives me hope at the same time. I think I still need some time until everything settles down. I will definitely try to get the prescription earlier next time.
Jim Allen:
Things can be overwhelming at first. Try not to overdo reading up on stuff, the basics are simple, take your meds, go to your check-ups and focus on living your life instead of focusing on HIV.