An HIV Information Site & HIV Educational Resource Site (HIS & HERS)

Adherence:  Taking Every Dose of Your Medications

Adherence is defined in the Unabridged Merriam-Webster dictionary as the following:

Main Entry: ad·her·ence
Pronunciation: ad-HERE-ance
Function: noun
Inflected Form(s): -s
Etymology: French or Medieval Latin; French adhérence, from Medieval Latin adhaerentia, from Latin adhaerent-, adhaerens (present participle of adhaerre) + -ia
: the act, action, or quality of adhering : as a
: ADHESION <adherence of paint to wood> b : steady or faithful attachment (as to a party, principle, or cause) : continued observance : FIDELITY <fierce adherence to what seemed true -- Times Literary Supplement>

In the setting of medical treatments for HIV and AIDS, adherence refers to following a treatment plan.  A medical treatment plan usually consists of one or more of the following:

1.  Schedule of visits with a healthcare provider: how often to go
2.  Medication plan which includes

a.  what medications to take and what medications to discontinue
b.  when to start medication
c.  how often to take the medication each day or week
d.  how many pills or capsules or teaspoons to take at each dose
e.  what times of the day to take the medication
f.   what relationship to meals to take medications: on an empty stomach or with food
g.  what medications to avoid taking with your medications

3.  Dietary plan: what foods to eat and how much (calories) as well as what foods to avoid
4.  Exercise plan
5.  Schedule of medical tests and referrals
6.  How to give feedback to your provider:
how and when to communicate with your healthcare provider (during the day, afterhours, weekends, holidays; by telephone, emails, smoke signals, teletype, Morse code, telepathy, etc.)

For HIV therapy to be successful, many studies have shown that at least a 95% level of adherence to medications is necessary.  If one achieves less than that, the therapy actually becomes harmful by allowing HIV to become resistant to the treatment.  Once this resistance to treatments develops, the resistance will stay with that patient for the life of the patient.  Resistance can usually be overcome, but at the price of changing medications, taking more pills, having more frequent dosing of medications, seeing one's healthcare provider more frequently, possibly having more side effects, and taking more lab tests.

Therefore, the author of this site believes that the patient should either make a commitment to take every dose of therapy every day OR take none at all until they are ready to commit.  The author calls this the "all or none" principle of HIV therapy with medications. Underlying this principle is the fact that starting therapy is usually not urgent and doing things completely right is more important than doing things “half-right” or “partially right.”

Taking 95% of your medications is not easy especially for someone that may not be used to taking medications.  NO one is saying that that goal is easy.  In fact, 95% is a hard goal for many people, but it's not impossible especially with many of today's latest combinations of medications.  Taking 95% of your medications IS NECESSARY for the success of your therapy and improving your health.  If you cannot achieve that goal, consider holding off therapy until you can achieve the goal.

The following suggestions are important for success with antiretroviral medications:

Suggestion Comments
Always begin new antiretroviral medications all at the same time. Antiviral medications should all be started together so that they can work together to reduce the amount of virus successfully.  If they are started one at a time, they may not work as well or at all.  It's even possible that the virus can develop resistance if medications are started one at a time.  If you cannot acquire all your medications at one time, do not start any of them until you have gotten all of them.
Read the labels carefully on all your medications and take them exactly as advised. Never change the number of pills or how often to take them without advice from your healthcare provider.
Understand medication dosing terminology and food requirements. Learn the following medication terminology:
"once a day" means as close to every 24 hours as possible or everyday at the same time of the day
"twice a day"
means as close as possible to every 12 hours as possible,
"three times a day"
means as close as possible to every 8 hours as possible and
"four times a day"
means as close as possible to every 6 hours as possible.
"with food" means immediately before, during, or immediately after eating. 
"on an empty stomach"
means at least an hour before you have eaten or at least 2 hours after you have eaten.
Use a weekly pillbox and arrange all your medications a week in advance. This is one of the most important things to do.  If you don't follow any other of these suggestions, this is the one to follow
Never let your medications run out. When you have filled your weekly pillbox and there is less than a week left in the bottle, call your pharmacy for a refill.  If a new written prescription is needed by the pharmacy, notify your healthcare provider as soon as possible, and let that person understand the urgency of the situation.  Never start medications unless you know where your next supply is coming from; if you cannot be sure that you will not run out, do not start antiretroviral medications until you have a guaranteed supply.
In most cases if you have to stop one of your HIV medications, stop them all. Start them all together unless otherwise instructed and stop them all together unless otherwise instructed.  There may be exceptions to this with nevirapine and efavirenz.
It is very important for you to see your healthcare provider at scheduled visits and it is very important to get all recommended lab tests done. Try to make every appointment, but if you cannot get to the office for whatever reason, call the office and reschedule for another appointment as soon as possible.  If you cannot see your healthcare provider very soon, ask your healthcare provider if you can get the appropriate lab tests done as soon as you can come to the lab.  This kind of arrangement usually works out very well.
Obtain a small pillbox to carry with you. Keep one or two doses of all your medications with you in case you are away from your supply when you need to take a dose.
Leave small supplies of medications elsewhere if needed. Stash a dose or two at work, at your relatives' house, or other places that you find yourself and need to take medications.  For example if you like to sleep over at a friend's house, keep a dose or two there.  Be sure to replace this extra supply when you use it up.
Work out a plan in case you fall asleep before your last dose of medication. If you fall asleep before your last dose of medication, ask someone to wake you up or set an alarm clock or watch to do so.  Or consider taking your late dose with your evening meal (except for Sustiva) each day even if the timing of the dose is not quite perfect.  Better to take it at a little off the perfect timing, than to miss it completely.
Notify your healthcare provider of any problems as soon as possible. Let your provider know about loss of medications, incorrect prescriptions, and problems getting any of your medications.  Report promptly any side effects that bother you, especially ones that get worse (for example, diarrhea, nausea, vomiting, turning yellow, rash, fever, weakness, breathing problems, stomach pain).  Try not to stop the medications that may be causing the problem until you have spoken to your provider or someone that knows a lot about HIV medications.
Never add any medications to what you are taking without consulting with your healthcare provider. Do not take any medications without the approval of your healthcare provider.  This "rule" includes over-the-counter medications, vitamins, herbal products, homeopathic meds, recreational drugs (for example, cocaine, alcohol, Ecstasy, crystal meth) and previously prescribed medications.  The same thing goes for medications prescribed by other healthcare providers who may not know as much about HIV medications as your own HIV provider; do not start these medications without consulting with your main or primary care provider unless it is an emergency situation.  Note that taking certain recreational drugs with antiviral medications has resulted in death.


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