ARVs are for life and a commitment to live
To succeed in treating HIV, it’s up to you to be responsible for your health and take your medication (ARVs) exactly as directed.
Taking your ARVs as prescribed is called ‘adherence’. This means taking the medication in the correct dose, daily and exactly as your healthcare worker has instructed you – without stopping your treatment or skipping any pills.
ARVs only stay in your body for 24hrs, which is why you need to take them consistently – ensuring that there is always the correct level of medication in your bloodstream working to keep the HIV under control. This is vital – remember, ARVs do not kill HIV or cure you of the virus, what they do is prevent it from replicating.
ARV treatment can also make your HIV powerless by reducing the HIV levels in your body to such a degree that you can’t pass it on to someone during sex (even without a condom). This is called “undetectable equals untransmittable”, or “U=U”.
Even if your HIV levels become suppressed (undetectable), if you do not continue to take your ARVs as prescribed, the HIV levels will start to increase again and you will not remain undetectable.
Adherence to your HIV treatment means:
• Taking all the medicines that make up your HIV treatment in the right quantities.
• Taking your medicines at the right time, as close as possible to the same time each day. Usually, this means taking the drug within a two-hour window (up to one hour on either side of the set time).
• Following any instructions about food. Some medicines need to be taken with food so they are absorbed properly, but others need to be taken on an empty stomach. Ask your healthcare worker about your specific treatment combination.
• Checking for interactions with other medicines or drugs. This includes medicines that a doctor prescribes to you, over-the-counter products, herbal and alternative medicines, and recreational drugs.
• Do not crush your medication if you have difficulty swallowing tablets. Crushing your tablets will result in less of them getting absorbed and getting discarded out of the body quicker.
Does it matter if I miss some doses of my HIV treatment?
You should aim to take your pills at the same time each day so that it becomes a habit. If you are used to taking all or nearly all your ARVs at the right time and in the right way, you are much better placed if you have a problem such as forgetting a dose, being away for a night without your medication, or running out of pills.
In studies, the missing of doses has been associated with an increase in viral load, a fall in CD4 cell count, and an increased risk of resistance. The best results of HIV treatment are seen in people who take all, or nearly all, of the doses of their drugs in the right way. The ideal is 100% adherence but life happens and sometimes you are in a situation where you miss a dose. Missing one dose is not the end of the world but you should avoid missing more than twice doses a month.
What should I do if I miss a dose of my HIV treatment?
What you should do about a missed dose will depend on the circumstances. In most cases, the safest option is to take the missed dose as soon as you realise and then to return to your normal schedule. If you only realise you have missed a dose when you come to the next dose, take the normal dose. Do not take a double dose to compensate for the one you have missed. If you miss a dose and are not sure what to do, it’s a good idea to contact your clinic for advice.
If you vomit (are sick) after taking your HIV treatment for whatever reason, you generally do not need to take another dose, as the drugs will already have been absorbed into your body. Exceptions to this are if it is less than two hours since you took your anti-HIV medications (or less than four hours if you are taking Eviplera or rilpivirine), or if you see the pills, or bits of them, in the vomit.
If you are regularly missing doses of your medication or taking them late, talk about this with your healthcare worker or doctor. They will be able to offer advice and support. In some cases, it may make sense for you to change your treatment to a drug combination with a lower risk of resistance.
Some of the risks of not adhering to your ARVs include:
• Your HIV infection may become resistant to the medication – this means that the treatment will no longer keep the infection under control – the virus gets a chance to mutate which may make the ARVs you were on ineffective. If that happens, you will never be able to use that medication again as it will not work – please remember that there are only a limited number of drugs available to treat HIV.
• The virus will be able to replicate and you will end up with a high viral load in your body – a high viral load means that treatment is failing, and your body is becoming weak.
• The virus becomes stronger and there is more of it to attack your body and weaken your immunity; you can become sicker or die sooner.
• HIV damages your immune system faster and this will make you vulnerable to catching STIs and contracting opportunistic diseases.
• Opportunistic diseases (like TB) make you sick, impact your health and appearance. They will also negatively impact your lifestyle as well as permanently damaging your health if you survive them.
• You are more likely to pass HIV on to a partner.
• You can potentially be exposed to other strains of HIV (if you have unprotected sex with another positive person who is not on treatment). This could significantly impact very badly on your health and you can become resistant to treatment.
So how can you ensure that you adhere to your treatment schedule? Here are some tips:
• At the beginning of each week, divide your pills up into daily doses using a pillbox – this way you simply need to open the correct day and drink your tablets. Planning makes pill-taking much easier.
• Work your pill-taking into your daily routine- for example, take them after brushing your teeth and leave your pillbox next to the toothpaste in your bathroom cupboard.
• Make sure you do not run out – keep an emergency supply of a few pills just in case.
• Set an alarm on your phone to go off each day at the correct time to take your tablets. It is also advised to use the recurring function so that if you miss the first alarm, that it will go off again.
• You can also speak to EMH to help guide you if you have problems with adherence.
Engage Men’s Health is in Johannesburg, Nelson Mandela Bay and Buffalo City. We provide free HIV and STI screenings, PrEP, ARVs and HIV self-testing kits. Whatsapp or Telegram us on 082 607 1686 for these services or for more information.
* Source AIDSMAP