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Taking your HIV treatment ('adherence')

taking treatment

Taking all the doses of your HIV treatment at the right time (‘adherence’) is very important. Poor adherence can lead to drug resistance, which means your treatment would stop working. Try our ideas for improving your adherence.

How should I take my HIV treatment?

You will get the most benefit from your HIV treatment if you take it exactly as it is prescribed.

This means:

  • Taking the correct dose.
  • Taking your pills at the right time, and roughly at the same time every day (within a couple of hours).
  • Following any advice about food and drink.
  • Checking for any interactions with other prescribed drugs, over-the-counter medicines, herbal or alternative treatments and recreational drugs.

Ideally, the aim should be to take all your doses in the right way.


Why is it so important to be on effective treatment?

The PARTNER study found that if someone is on effective HIV treatment and has an undetectable viral load, they cannot pass on HIV. It can take up to six months for some people to become undetectable from when they start treatment – this was established by the Partners PrEP study.

The START study also found that people who delayed treatment until their CD4 count dropped to 350 had a significantly higher chance of developing AIDS-related illnesses.

The British HIV Association (BHIVA) now recommends that anyone with HIV who is ready to commit to treatment should start taking it regardless of their CD4 count.


What happens if I miss a dose?

If you do forget a dose of your combination therapy, try not to panic or feel guilty – we’re all human!

As a very general rule, if you realise you have missed a dose, take it as soon as you remember. But if you only realise when you’re going to take your next dose, don’t take a double dose. If you’re not sure what to do, you could ring your HIV clinic to ask.

You usually don’t need to take another dose of your HIV treatment if you vomit (are sick) after taking it, unless you see the remains of the pills in the vomit. If it is more than an hour after taking your treatment (or more than four hours if you are on Eviplera or rilpivirine), the drugs will already have been absorbed into your body.


Here are some strategies to help you take your treatment:

Practice first. To get into the routine of pill-taking, you could practise for a few weeks before starting. Try having mints or vitamin tablets at the times you’ll be taking your treatment. Learn from this and work with your healthcare team to come up with a schedule that is right for you.

Remembering by association. Keep your medication in a place where you will remember to take it and try to link your pill-taking times with other daily routines – eg, getting up, going to bed, meal times, taking the children to school, a particular radio or TV programme, or tea breaks at work.

Right place and time. Collect your new prescription in plenty of time to ensure you have a good supply of drugs and make sure you keep your drugs in a safe, dry, cool place, away from children. Bathrooms are not ideal because of the humidity.

Compartmentalise. You can probably get pill containers or dosette boxes from your clinic. They have compartments so you can divide up your tablets according to when they need to be taken. They can help if you forget which pills to take, or if you’re not sure whether you’ve already taken your pills.

Reminders. Keep a note, a picture or some other reminder on the back of your front door to remind you to take medication with you before leaving home. You can also set an alarm on your mobile phone or your watch to ring when your doses are due, although this can draw the attention of other people.

Keeping tabs. If you keep a diary or pill planner, you can tick off each dose once you’ve taken it. If you use a computer at work, you can use the calendar or task programme to automatically send you reminders. You could use a code word to mean anti-HIV drugs. You can also use the My medication and reminders tool on this website to ensure you take your treatment on time.

No surprises. Plan for weekends, holidays or other times when you don’t have your usual routine. Make extra efforts to remind yourself and, if appropriate, ask the people you’re with to remind you. Take extra medication in case your scheduled return is delayed.

Have water. Keep a bottle of water in your bag, so you can take your treatment wherever you are. If you don’t want people to see you taking your treatment, excuse yourself to go to the toilet or to make a phone call.

Never run out. Avoid running out of your medication by renewing your prescriptions in advance.

Ask for help. Ask a partner, trusted family member or friend to remind you to take your doses.

Emergency dose. Keep an emergency dose close at hand – eg, in your bag, glove compartment of a car or at a partner’s or friend’s home. If you ever have to go to an Accident and Emergency (A&E) department of a hospital, take sufficient HIV medication with you in case you are admitted.


Is help available with adherence?

A lot of support is available to help you increase the chances of taking your treatment in the right way.

You can also use our My medication and reminders tool to set email reminders to take your treatment every day.

You are likely to find treatment easier to take if it fits in with your daily routine and the way you live your life. There are some practical tips for taking your treatment at the right time and advice for taking medication at work.

It makes good sense to talk about this with your HIV doctor or another member of your healthcare team when you are deciding which combination of drugs to take.


Next: Resistance to HIV drugs ››

‹‹ Back to: Side effects of HIV medication

 

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The Information Standard: Certified member

This article was last reviewed on 3/7/2014 by R. Bignami

Date due for the next review: 1/7/2017

Content Author: S. Corkery, NAM

Current Owner: Greta Hughson (NAM)

More information:

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy
Mujugira A1, Celum C, Coombs RW, Campbell JD, Ndase P, Ronald A, Were E, Bukusi EA, Mugo N, Kiarie J, Baeten JM; Partners PrEP Study Team
2016 Aug 15;72(5):579-84. doi: 10.1097/QAI.0000000000001019.
National Center for Biotechnology Information
US National Library of Medicine

HIV treatment as prevention and HPTN 052, Cohen MS1, McCauley M, Gamble TR
National Center for Boiotechnology Information
US National Library of Medicine

BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update), Laura Waters, N Ahmed, B Angus, M Boffito, M Bower, D Churchill, D Dunn, S Edwards, C Emerson, S Fidler, M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston
British HIV Association (BHIVA)

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy
Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD1; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD
JAMA. 2016;316(2):171-181. doi:10.1001/jama.2016.5148
Journal of the American Medical Association

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Drug interactions
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Some things that might help you to take your treatment
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Adherence tips
i-Base
1/9/16

START trial finds that early treatment improves outcomes for people with HIV
Gus Cairns
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27 May 2015

START trial provides definitive evidence of the benefits of early HIV treatment
Liz Highleyman
Produced in collaboration with hivandhepatitis.com
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21/7/15

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy
Mujugira A1, Celum C, Coombs RW, Campbell JD, Ndase P, Ronald A, Were E, Bukusi EA, Mugo N, Kiarie J, Baeten JM; Partners PrEP Study Team
National Center for Biotechnology Information
US National Library of Medicine
2016 Aug 15;72(5):579-84. doi: 10.1097/QAI.0000000000001019.

HIV treatment as prevention and HPTN 052
Cohen MS1, McCauley M, Gamble TR
National Center for Boiotechnology Information
US National Library of Medicine

Williams I et al. BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012 (Updated November 2013)

http://bhiva.org/documents/Guidelines/Treatment/2012/hiv1029_2.pdf