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Author Topic: 1-3 hours late with Sustiva/Truvada  (Read 8869 times)

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Offline LordBerners

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1-3 hours late with Sustiva/Truvada
« on: September 19, 2008, 05:01:44 AM »
I was recently mildly reprimanded by docs about taking Sustiva/Truvada at as much as two hours differing times at night. 

Can anyone comment on this?  I had not been previously informed that a small difference in dosing time would be disastrous. 
Please, just call me Berners.. or Baron.

Offline tag_man08

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #1 on: September 19, 2008, 06:49:19 AM »
I've always heard you have a one hour window.  You should stick with the same time every day that works best with your schedule.  You never want to give the virus any window of opportunity to mutate and cause you to become resistant to your present class of drug.  I think most people take your combo at nite to sleep through the side effects related to the sustiva.  Good Luck buddy.
08/30/07:  The HIV diagnosis...
09/07/07:  CD4 299 (21%)  VL 160K
01/07/08:  CD4 396 (26%)  VL 125K
04/21/08:  CD4 478 (25%)  VL 92K
09/03/08:  CD4 313 (23%)  VL 10K
11/03/08:  CD4 338 (23%)  VL 30K
11/21/08:  Isentress & Truvada
12/05/08:  CD4 485 (29%)  VL  undetectable in two weeks
03/13/09:  CD4 575 (30%)  VL  undetectable

Offline Finnboy

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #2 on: September 19, 2008, 06:55:04 AM »
How did we get from being “mildly reprimanded” to it being “disastrous” .. or was that just you using poet licence for added dramatic effect? ;)

The problem is that whenever your drugs are at sub-therapeutic levels, you are giving the virus an increased chance of replicating and mutating. Compared to other drugs available, Sustiva degrades very slowly (which is why stopping Sustiva always needs to be so carefully managed); but the components of Truvada degrade quite quickly and soon reach ineffective levels.

With Truvada you are realistically looking at a two-hour window for taking your medication (which means +/- 1 hour from schedule, not +/- 2 hours) so if you are going to make a habit of missing your scheduled medication time (presumably to manage Sustiva side-effects) then you are far better off taking your Truvada on schedule and only messing around with the time you take Sustiva.

The very occasional slippage isn't likely to be a major issue; but even slipping once a month does start to significantly increase the likelihood of you developing resistance to one, or both, of the drugs in Truvada.


Offline jabez

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #3 on: September 19, 2008, 02:47:42 PM »
Apparently the answer to this question is, "It depends on whom you ask."

I've noticed that this question has been posed about half a dozen times in the "Ask the Experts" column on The Body website.   One of the doctors consistently says, "Sustiva and Truvada have long half lives, so a couple of hours in either direction is fine."

Another one of the doctors on that website consistently says, "You should always take your meds at the SAME TIME every day.  Period."

So there seem to be a couple of different schools of thought about how much leniency you can allow in dosage.   I've never allowed more that an hour, just to be sure.   There ain't any sense in jumping around 2 or 3 hours with it, if that can possibly be avoided.   I understand that occasionally you might need to have a lapse of a couple of hours, and I wouldn't worry myself to death about it when that happens.   But I wouldn't do it just for the hell of it. 
Sept 2007 -- CD4 = 68; VL = 469,000
Started Atripla Sept 21, 2007
Nov 2007-CD4=217;VL=332
Feb 2008-CD4=237;VL=<50
Apr 2008-CD4=271;VL=66
Aug 2008-CD4=440;VL=52
Jan 2009-CD4=403;VL=61
May 2009-CD4=480;VL=129
Sep 2009-CD4=376;VL<40
Jan 2010-CD4=476;VL<40
Jul 2010-CD4=539;VL<40
Jan 2011-CD4=461;VL=53
Jul 2011-CD4=515;VL<20
Jan 2012-CD4=506;VL=54
Aug 2012-CD4=440;VL=21
Jan 2013-CD4=447;VL=<20
Jul 2013-CD4=406; VL=<20
Feb 2014-CD4=450; VL=<20
Aug 2014-CD4=535; VL=<20
Feb 2015-CD4=535; VL=<20
Aug 2015-CD4=707; VL=<20

Offline LordBerners

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #4 on: September 19, 2008, 04:15:49 PM »
Thanks for the comments gentlemen.  My changing the time of dosing was due to large shifts in my bedtime.  I shall have to pin it down more precisely in future.  Very helpful point about the Truvada Finnboy - I think it is probably the Sustiva which causes the dizziness I was trying to keep during sleeptime by dosing a bit late.
Please, just call me Berners.. or Baron.


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Re: 1-3 hours late with Sustiva/Truvada
« Reply #5 on: September 19, 2008, 05:22:36 PM »
If your viral load is undetectable I would not worry about your lapse of 3 hours. I think you doctor wants you to understand the importance of maintaining perfect adherence to your meds. Better to be overly cautious about being on time about taking your meds than think its OK to take them when you feel like it. And I have also heard if you are in the 2 hour range you are doing great.
Atheist don't believe in GOD, but GOD believes in them and loves them. Never let the failure of man conflict with your love of GOD.

Offline havisham

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #6 on: September 19, 2008, 07:18:02 PM »
I work irregular shifts, and I take my Truvada at 10pm, whatever, and I aim to take the Sustiva at 11.30 when I can, but the white coats say I can vary it by about two hours in either direction - between 9.30pm and 1.30am, depending what time is bedtime for that day.
Saves me from having to work through the weird drunken feelings. I have to stick to those boundaries rigidly though.
Having said that - adherence is everything, and you can't mess with it. If you're finding you need to vary it, talk to your doc first.
I've been doing it like that for about three months now, and my VL has dropped to undetectable, so it's worked out OK for me.

"Bigger teeth than those of mice have gnawed at me."

Offline tash08

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #7 on: September 19, 2008, 07:51:27 PM »
I'm on the same combo and I try to take it at the same time every day at 10 p.m I take it few minutes earlier or later depending on my schedule as to make sure that I can keep the bug from reactivating.  Most of the doctors say it stays in your system up to 48 hrs but there are a lot of factors influencing blood saturation with the drug so I do not want to take any chances of resistance.

Tenofovir(Viread) Half life-17 hours
Efavirenz(Sustiva) Half life 40-55 hours
Emtricitabine(Emtriva) Half life- 10 hours
04/01/10 CD4-681, VL-UD
07/10/10 CD4-450, VL-UD
10/10/10 CD4-473, VL-UD
01/21/11 cd4-522, VL-UD
05/02/11 CD4-638, VL-UD <20 copies Hell yeah!
08/3/12 CD4-806, VL-UD

Offline newt

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #8 on: September 19, 2008, 08:05:39 PM »
It's not the half-life that's important, it's the time to minimum effective concentration, in the case of tenofovir and FTC, the 2 drugs in Truvada, this is complicated because of the intracellular concentration being the important one, not the peripheral blood concentration.

Taking Sustiva + Truvada 1 x day with +6 hours of the last dose is probably sufficient for most people (are you most people?).

- matt
"The object is to be a well patient, not a good patient"

Offline Finnboy

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #9 on: September 20, 2008, 02:56:47 AM »
And please be aware that Matt's example of + 6 hours doesn't mean +/- 6 hours.

In setting yourself easily manageable windows, you have to allow for when you could have taken the previous dose: If one dose is taken three hours ahead of schedule (in preparation for an early night before a long day ahead) and the next dose is taken 3 hours late, then you are already at the maximum extreme of the +6 hours at which most people are probably OK.

As Matt says, are you really most people? For me personally, I can't really think of many aspects of my life with HIV where I fit the profile of this mythical, averaged out, 'most people' person.

Offline LordBerners

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #10 on: September 20, 2008, 06:19:49 AM »
Thanks so much everyone for your comments, mostly reassuring.  I have in fact never gone outside a six hour window - never more than three hours late (in fact I think not more than two, but I can't remember for sure). 

However I do not see the downside of being 'early', as long as the new earlier time became one's subsequent standard or reference point.

Lastly as I am only around six weeks into the regimen I suppose it behooves me to be particularly careful now, as it is unlikely I'm yet at 'undetectable' levels.. not that I'm saying I know for sure, but it seems to make sense that the risk of resistant mutations should be somewhat higher the more copies there are replicating in one's body.
Please, just call me Berners.. or Baron.

Offline blondbeauty

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #11 on: September 21, 2008, 10:55:02 AM »
I always take my sustiva and truvada at bedtime. Sometimes at midnight, at 3.00 am or even at 5.00 am and I have been undetectable since my third month on treatment. I think this regime is a very forgiving one.
The only member in these forums approved by WINBA: World International Nail and Beauty Association.
Epstein Barr +; CMV +; Toxoplasmosis +; HIV-1 +.
Counts when starting treatment:
V.L.:80.200 copies. CD4: 25%=503
Started Sustiva-Truvada 14/August/2006
Last V.L.count (Oct 2013): Undetectable
Last CD4 count (OCT 2013): 52%= 933

Offline newone

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Re: 1-3 hours late with Sustiva/Truvada
« Reply #12 on: September 21, 2008, 11:21:49 AM »
Hi Blondbeauty..
I switching from Sustiva/Truvada to Atripla...I guess the ingredients are the same and I hope as forgiving as the other combination...I usually take mine between 08.00am and !0.00am.
Sustiva, Truvada
cd 212 Mar 04
cd 265 May 04 (started meds)
cd 690 Nov 07 (26%)
cd 771 Apr 08 24%
cd 737 Sep 08 27% Atripla
cd 875 May 13 32% Eviplera
cd 845 Jul 13  30%

Offline timpoz

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  • TimPoz
Re: 1-3 hours late with Sustiva/Truvada
« Reply #13 on: September 21, 2008, 12:00:39 PM »
Hey Guys.  I'm new to the Blog thing here.  I'm not on the same combo but on Reyataz/Truvada/Norvir.  I work night shift and glad to say I have no side effects regarding these meds.  I mean absolutely none.  (crossing my fingers)  I started taking them during after my breakfast meal but by the time I get home from work it's 9-10am and its almost lunch time then I had adjusted them to with dinner.  But then dinner sometimes don't happen till 10p or 11pm.  I don't want to hav eto bring my meds to work as I might forget to take it or lost or worse, somebody goes thru my bag and steals it as a prank.  So I just take my meds after breakfast and that happens between 7am and 12noon.  Thank God I am still undetectable.  Anyone else out there on my combo?  How are you doing with it?  I'ld like to know your experience with these meds.  Thanks!!!!   Tim


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