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    The importance of Adhering to Your Treatment Regimen

    An introduction

    One of the most important things to think about before beginning treatment for HIV disease is your ability to take the treatments properly. This is called "treatment adherence," and it may sound easy, but sometimes it's not. Studies show that even doctors have enormous difficulty taking even short-term drug regimens strictly according to the rules.

    As far as we know, anti-HIV medicine has to be taken for life. Not taking the medicine properly can lead to "drug resistance," where HIV mutates and becomes resistant to a drugs effect. This in turn leads to treatment failure. Therefore, it's important to plan adherence strategies in advance.

    You should raise questions about treatment adherence with your doctor when you're deciding what treatments to take. Different drugs have different rules - some drugs may be taken only once a day, while others must be taken with a high-fat meal. Because you will probably be taking several different medications, each drug may have different rules. It's importance to know which drug goes with which rules.

    What do I need to know to ensure good adherence?

    • How many pills of each different medicine are you supposed to take at a time?
    • How many times a day are you supposed to take each medicine, when do you take them?
    • What are the food requirements for each different medicine?
    • What should you do if you forget a dose?

    Planning a drug regimen that works with you schedule will help to improve your adherence. For instance, if you're often travelling from place to place in the middle of the day, then a drug that involves a dose in the middle of the day may give you problems. If you tend to eat at different times each day, then drugs with strict requirements about eating may give you a problem.

    As you are considering different treatment regimens, plan out schedules that include the things you regularly do - such as taking your kids to school, going to work, or eating a late dinner - and then think about how different drug regimens might affect that schedule. For instance, let's compare two different treatment regimens.

    Time of Day
    Sustiva + Combivir
    Norvir + Crixivan + Videx EC + Zerit
    6.30 am Wake up Wake up, take Videx on empty stomach & 1 hour before eating
    7.30 am Breakfast Breakfast, take Norvir, Crixivan, and Zerit
    8.00 am Go to work Go to work
    10.30 am Coffee break, take combivir with a snack Coffee break
    12.30 pm Lunch Lunch
    6.00 pm Go home Go home
    Dinner Dinner, take Norvir, Crixican, and Zerit
    10.30 pm Take Combivir and Sustiva, go to bed Go to bed

    You can see from these schedules how different drug regimens have different effects on your day.

    Is there a way to prepare for a complicated drug regimen?

    Sometimes, if you're not sure you can handle a drug regimen with a complicated schedule, it might be wise to practice a little first before starting the actual drugs.

    This might sound silly, but you might try to use jellybeans first! Think of it as an experiment to see if you can adhere to a treatment regimen. For instance, a bag of red jellybeans might represent Videx and would be taken once a day on an empty stomach. A bag of blue jellybeans might represent Zerit, and would be taken twice a day with or without food. A bag of green jellybeans might represent viracept, and you'd take give green jellybeans twice a day, with a meal or a light snack.

    By following the jellybeans regimen for a week or two, you can find out whether or not the schedule works for you. You can also spot potential problems times, and try to find solutions. That way, when you actually start the medicines, you've already taken important steps to change your schedule.

    Once you think you're ready to start taking a new drug regimen, make sure to ask your doctor any questions you still have before she or he writes the prescriptions. One of the biggest problems with adherence is doctors who don't communicate enough information. Make your doctor write down the instructions for taking your medication, and read them back to her or him. It can be easy to confuse "two pills three time a day" with "three pills two times a day", so it's important to be sure that you understand how many pills you're supposed to take, and how many times a day you take them.

    An important thing to know is that the times that you take the drugs are important. In other words, if your doctor says to take a drug every twelve hours or every eight hours, then it's important to stick pretty close to that schedule. Taking medicine properly prevents drugs resistance - the longer you wait to take a dose, the less there is of the previous dose in your system to fight HIV and drug resistance.

    This all sounds to difficult, Is there an easier way?

    It's just common sense, but it's important to know that there are studies showing that simpler treatment regimens are easier to adhere to than more complicated regimens. In other words, a drug regimen that involves fewer pills taken fewer times during the day may be easier to take properly than a drug regimen that involves lots of different pills taken may times a day.

    If you don't think you can stick to a proposed drug regimen, then don't start it. Ask your doctor about the possibility of taking an easier regimen instead. Either way, you shouldn't start therapy until you are ready. Starting a treatment regiment that you are very ill, it might be better to wait until you're ready and able, or until easier treatment regimens become available.

    Once I've started treatment, are there tools to help me stay compliant?

    Yes! There are a number of tools you can use to help you remember your doses. For some people, a schedule on their refrigerator reminds them to take their medicine. Others rely on electronic pillboxes this beep at the appropriate time. Or how about a digital watch with multiple alarms.

    Think about creative ways to remind yourself to take your medicine when you're supposed to take it. It also helps to recruit family and friends to help you remember. Encourage the people around you to ask, "Did you take your medicine today?" Lets face it - moral support is important!