Managing HIV: Adherence To HIV Therapy

What is medication adherence?
Adherence means that you take all your medicines exactly as they are prescribed. That means you take them when and how they are supposed to be taken. For example, if a medicine needs to be taken every 6 hours, adhering to that regimen means that you really take the medicine at those time intervals and that you don’t miss any dose. Adherence also includes how you take your medicines. For example, some medicines must be taken on an empty stomach to be effective, while others need to be taken with food.

How you can prepare for this discussion

* List daily activities that may interfere with regimens
* Note if you have had trouble adhering to medication regimens in the past
* Note your eating and sleeping habits

Why is adherence to HIV medications important?
The current recommendation for the treatment of HIV disease is called HAART—highly, active, anti-retroviral therapy. HAART regimens combine three or more HIV drugs that need to be taken according to strict dosing schedules. Adherence is important because missing a dose can cause the levels of the HIV in your body (viral load) to increase. Also, when doses are skipped there may not be enough medication in the body to stop the virus, which may allow the virus to become immune to the medicine. This may make the HIV medicines you are currently taking, or even new medicines that you may need to take in the future, ineffective. These drug-resistant HIV strains are much more difficult to treat.

How you can prepare for this discussion

* List daily activities that may interfere with regimens
* Take a look at your work and travel schedules
* List all prescription, over-the-counter medications and dietary supplements you are taking <
* Note if you have had trouble taking medications in the past

Why do people have trouble sticking with their HIV drug regimens?
Adherence to HIV medications is a challenge. Some people with busy lifestyles simply forget to take them. Others may find it difficult to manage the pills that need to be taken at specific times of the day. In addition, since some medicines cannot be mixed with certain foods, alcohol or other medicines, adhering to some regimens can be very complicated. People who may otherwise feel well may not be able to cope with some of the medication side effects. Others feel that taking medicines when they feel well reminds them of having a disease that they would rather not think about. Your doctor will want to know if you have had trouble with complicated medicine regimens in the past.

How you can prepare for this discussion

* List all dietary preferences or restrictions
* Note how much alcohol you drink
* Make a note of your daily routines and habits
* List any side effects to medications you have experienced in the past
* List all prescription, over-the-counter medications and dietary supplements you are taking

What are some strategies to keep the HIV medication regimen in track?
People who are contemplating beginning therapy are sometimes encouraged to first practice taking candies or mints as if they were the exact medicines in their regimen to see how well they can manage the regimen. Once you have decided to start therapy it will be important to integrate the regimen into your lifestyle. Some of the following strategies can help you adhere to your medication regimen:

* Use daily medication organizers or pillboxes
* Use an alarm device or electronic PDA
* Keep a medication diary and checklist
* Keep an extra supply of medicines on hand
* Integrate the regimen into daily routines
* Utilize a support network

How you can prepare for this discussion

* Look for patterns in your daily schedule
* Note how well you were able to take other medications such as antibiotics
* Think about who in your life might be considered part of your support network

What can my doctor do to help?
Although some people learn to cope with complex regimens, others can find it too difficult. Discussing these issues with your doctor will help him/her recommend a regimen that is a better fit for you lifestyle. Certain combinations of medicines can be chosen over others and dosages can sometimes be adjusted. To avoid missing doses because you were unable to obtain your medication, you may want to ask about drug assistance programs in your area.

How you can prepare for this discussion

* Write down your questions and concerns and bring them to your doctor’s visit
* Educate yourself about new treatment regimens
* List all prescription, over-the-counter medications and dietary supplements you are taking
* Assess your insurance coverage and financial resources

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