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Author Topic: Adherence?  (Read 940 times)

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Offline Hope4life

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Adherence?
« on: November 17, 2018, 03:02:49 am »
Hi Everybody,
I have a question regarding the definition of adherence?
I was told by a medical person that I have to take my medicines (Telura generic version of atripla) exactly at the same time every day ???. however I read many discussion on some other platforms where doctor discussed that the drugs contained in Telura are of high half life and they remain in the blood circulation for longer period, hence the time of the dosage hardly matters. What matters is that we should take that everyday without missing any dose (though I know FOTO study too).
I generally take my drug around 11 PM to 12 PM depending on the time of dinner. However in last 8 months there were only 5-6 instances where I slept early so I took medicine at 10 PM or because of the some other reason I took it at 2 AM. But i never missed my dose :). So does that make me nonadherent or Am I not following the rules of adherence?
FYI I am undetectable and cd4 count is ~580.
Thanks

Online JimDublin

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Re: Adherence?
« Reply #1 on: November 17, 2018, 05:03:09 am »
So 5 doses a few hours late or early over 8 months

Even if you had totally skipped 5 doses over 8 months, by my calculations you would still have met the often cited  ≥95% (perfect) adherence to your antiretroviral therapy. So worring about a few hours late, seems to me a bit over the top

Not that I recommend missing doses, aim for 100% don't let laxity creep in and a good routine helps. I'll admit thought I'm late by 3 hours twice s week myself with my own meds as it's called Saturday and Sunday  ;D

Quote
I was told by a medical person that I have to take my medicines (Telura generic version of atripla) exactly at the same time every day

Well yeah, of course they are going to be stressing max adherence and i would kind of expect them to communicate in absoluts on the topic to avoid laxity

Look I had a GP unnecessary freak out when I told them I missed 2 doses whilst traveling, I point blank asked him to control himself and cop-on to reality, I'm not new to this.

Anyhow if you are unsure as always speak to your doctor during your next clinc vist and ask for their input. All we can offer here is fellow patient thoughts and study debates.

Take it easy

Jim
« Last Edit: November 17, 2018, 03:17:57 pm by JimDublin »
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Offline Hope4life

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Re: Adherence?
« Reply #2 on: November 29, 2018, 12:10:34 am »
Thanks a lot Jim for the inputs. 


Offline Loa111

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Re: Adherence?
« Reply #3 on: November 29, 2018, 05:05:39 pm »
I wonder does a couple of hours time variation a couple of days a week make much different or not. E.g. I take my meds around 7am on average Mon-Friday...though sometimes it could be 6.30 am or sometimes 7.30am.

Then Saturday & Sunday, similar to Jim, it might be 9.30am  or so when I take them.

When I was on my previous med, Genvoya, I read on it's website that it was recommended to take within 2 hours of the same time daily. Though there was still an 18 hour window there if you forgot to take it.

Not sure what the recommendation is with Tivicay & Descovey I am on now re trying to be exact with time. Though both drugs also got an 18 hour (think 20 hour for one of them) window in case you miss a dose at the normal time.

Offline Ptrk3

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Re: Adherence?
« Reply #4 on: November 29, 2018, 07:30:21 pm »
No, a few hours this way or that won't matter.

Today's medications have long half-lives.  You should be fine.
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Offline bocker3

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Re: Adherence?
« Reply #5 on: November 30, 2018, 06:46:53 am »
The part of adherence to focus on is to NOT forget to take your pills.  For me:  that means developing a routine, so that it becomes a part of the day.  Much harder to forget.

Every morning, as I dress, I take my Reyataz and Norvir.  ((breakfast is also complete as they require to be taken with food).  This could be as early as 6:00 am and as late as 11:00 am

Every night, before bed, I take my Sustiva and Descovy.  This could be as early as 9:30 or as late as 2:00am.

Also, when I travel, I don't worry about time changes -- I stick to taking them in the morning, as I dress and before bed.  Whether I am 1 time zone away or 12.

I have NEVER had a blip since going UD back in 2007.

Habits help ensure adherence for me.

Oh, and I use a pillbox (with AM and PM compartments for each day), so there is never a doubt if I took them.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
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Offline terrymoore

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Re: Adherence?
« Reply #6 on: November 30, 2018, 09:22:15 am »
Boker3 (Mike) explains it best - and since he is the most experienced, we should listen to his sage advice.

I also developed a habit - every day after BF. Sometimes BF is early, sometimes late, sometimes big, sometimes just  banana and coffee. I need food with my pills (my only real burden).
I travel often and sometimes different timezones. I too stick to my routine - BF. If that means i need to take 2 doses within 24hours for the first day, so be it. I use a pill box too, set a reminder on my watch and phone - every day at same time in AM. Sometimes i turn it off when i want to sleep in (that rarely happens unfortunately! boohoohoo! :'( )

Offline CaveyUK

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Re: Adherence?
« Reply #7 on: November 30, 2018, 02:31:00 pm »
This was a question that used to pop up on Dr Gallants Tumblr forum quite a bit (when that was still going) around once-a-day pills.

The 'official' advice is to take at the same time, and certainly this is more important in the early days of treatment as the routine is established.

But generally taking them every day is far more important than a specific time. A few hours difference here or there really won't be a problem.

I tend to take mine at around 10pm, but have taken as early as 8pm and as late as 2am on a number of occasions.

So don't sweat it too much
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Offline bocker3

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Re: Adherence?
« Reply #8 on: November 30, 2018, 05:17:08 pm »
Boker3 (Mike) explains it best - and since he is the most experienced, we should listen to his sage advice.

I also developed a habit - every day after BF. Sometimes BF is early, sometimes late, sometimes big, sometimes just  banana and coffee. I need food with my pills (my only real burden).
I travel often and sometimes different timezones. I too stick to my routine - BF. If that means i need to take 2 doses within 24hours for the first day, so be it. I use a pill box too, set a reminder on my watch and phone - every day at same time in AM. Sometimes i turn it off when i want to sleep in (that rarely happens unfortunately! boohoohoo! :'( )

Just want to be clear -- I am not a doctor, nor a pharmacist, so I am not advising anyone to do anything differently than their medical team suggests.  My doctor suggests I take my pills as close as possible to the "same time" each day -- of course, I have gotten more comfortable deviating a bit from that over the years -- but that is MY CHOICE -- NOT MY ADVICE to anyone else.

What I am doing is giving others a look at what I have done to help ensure I don't forget to take my pills (probably have missed, on average, less than 1 dose each year since Dec. 2005).

Hopefully, what my experience can do is help others not overreact if they take their pills later than "normal" or "suggested".

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2015 969/28% <20

Offline Mindless

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Re: Adherence?
« Reply #9 on: November 30, 2018, 11:19:13 pm »
I used to take generic Atripla after the dx and my 1st doc run some terrorism on me about perfect punctuality every day (he got to advice me only a few +/- minutes tolerance). As Cavey says, maybe that's was just meant to establish a routine, I don't know. Anyways, I changed doc and meds (generic Complera, the "cousin" of Atripla) and the punctuality was even more difficult due to the food requirement and me traveling abroad for work regularly.
I was worried at the beginning and talked to my doc: he basically repeated all the advices above about meds long half life and focus on misses doses more than perfect timing.

After 2 years since dx and 1 from the med switch always been UD. As Bocker says, that's only my personal experience but I see it seems to be common experience.

M

Offline CaveyUK

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Re: Adherence?
« Reply #10 on: December 01, 2018, 06:44:08 am »
I think the meds these days are far more forgiving than the older generation drugs and some docs will think that if they don't hammer down the strict timing thing then people may just not take at all, and let's face it - it's easier for all of us if we have a routine. It's just that a few hours either way is unlikely to cause any problems.
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Offline fabio

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Re: Adherence?
« Reply #11 on: December 01, 2018, 03:22:37 pm »
Wow,and here I get paranoid by missing a minute my does haha. Of course I won't stop cuz I feel .ore secure (or OCD,lol).

Offline Mightysure

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Re: Adherence?
« Reply #12 on: December 20, 2018, 01:22:45 pm »
Your medical person is basing their instructions off of the first generation HIV treatments, which had extremely shorter half lives and some had to be taken multiple times per day.

You're correct in that these meds lsst longer, so while its preferable that you take your meds at the same time every day, you won't risk virological failure with a couple of hours either way.

Offline bufguy

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Re: Adherence?
« Reply #13 on: December 21, 2018, 03:22:42 pm »
Atripla is actually one of the more forgiving meds because of the long half life of the efavirenz component. There was a study done about 10 years ago called FOTO...FIVE days ON, TWO days OFF. Participants took atripla Monday through Friday and took Saturday and Sunday off. The participants all stayed undetectable and maintained their CD 4 count. The study was small so doctors were reluctant to use the results as a recommendation but it does show how robust Atripla is.
On a personal note I have been on Atripla for over 10 years. I have almost perfect adherence, but I do allow a window of as much as 4-6 hours depending on when I go to bed. If I go to bed at 10PM that's when I take it...If it's 2AM I take it then....I have been consistently undetectable, not even a blip and I have a CD4 that ranges from 800 -1000.
Just make sure you take your meds every day, but don't fret over a few hours.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .
11/29/18 vl un CD4 1080/39% CD8  .86

Offline harleymc

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Re: Adherence?
« Reply #14 on: December 27, 2018, 05:00:42 pm »
We're all going to be popping pills the rest of our lives.  I know doctors sometimes think of us just as pull popping patients but the reality is that I take pills to buttress and support my quality of life.

Ido not exist to take pills.

Offline fabio

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Re: Adherence?
« Reply #15 on: December 27, 2018, 08:37:05 pm »
I don't take it as philosophically. It happened,as of many reasons,that we are infected with this virus. I am very thankful to the pills. I believe now that the piĺls also gave me a chance to be realistic and to not see all this in a dramatic point of view.
There are people who don't have any effective treatment to their disease/condition and can't have such a good quality of life as we do.
Does taking pills suck? Yes,but so does dying. So living is our only option. Whether there is a lot of stigma and people who don't seem to grasp that we can live normally and can be undetectable/untransmitable,I don't really care. The world doesnt stop revolving and so does my life. Over all death I choose life,even with pills.

 


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