Drug Resistance & Adherence
When drug resistance occurs it may prevent your HIV treatments from working as well as they should, depending upon the level of resistance that develops. Drug resistance can be prevented, such as:
Adherence which is a technical term for taking your treatments routinely, in the way that your doctor has prescribed them.
The information on how to correctly take your treatments is written on the container your treatments come in, and upon the Consumer Medicine Information (CMI) leaflet that is also provided in the packaging that comes with your treatment.
Whether you are on a twice-daily or once-daily HIV treatment regimen, you need to take your pills daily (around the same time every day) whilst aiming for at least 95% (or better) consistent (every-day) adherence, without skipping or missing doses. Some HIV treatments are more ‘forgiving’ in terms of missed doses, but aiming for at least 95% consistent adherence is the best way to guard against resistance occurring for all HIV treatments.
Being 100% adherent is always the best safeguard against drug resistance, and may also improve the benefits against HIV.
A good way to measure whether you have achieved 95% consistent adherence in taking your pills is to do a pill count as follows:
- If at the end of a 30 day supply of ONCE DAILY treatment, you have no more than ONE (1) DOSE left to take, then you have been 95% adherent. Congratulations!
- If at the end of a 30 day supply of a TWICE DAILY treatment, you have no more than THREE (3) DOSES left to take, then you have been 95% adherent. Congratulations!
If you have any MORE than these amounts left in the pack or bottle, then your adherence to treatment is less than 95%, and drug resistance or drug failure can occur.
If you’re having troubles staying adherent to treatment, seek some support and tips on how to remember to take them, or over-come the barriers that might be causing you not to take them. There might be many reasons that adherence is a problem for you, and many of them are solvable with a bit of help.
Different people find different things help establish the daily routine. If there are things getting in the way of you taking your treatments or side-effects are bothering you, tell your doctor what your concerns are.
Tips for staying on your Treatment
TIP 1: Put your treatments in a place you visit as often as they need to be taken – at home or away.
TIP 2: Try using partitioned pill containers which you put each day’s dose into, and then you can clearly see if you have taken them or not – ask your pharmacist for these or call QPP and we can arrange to provide you one.
TIP 3: When first starting your treatment, try to take a break for a few days from your regular responsibilities, such as work. This may give you some privacy and peace of mind. Don’t start treatments when you have major commitments occurring elsewhere, such as a new project.
TIP 4: Remember it usually takes no more than about 10 seconds to swallow pills. That means you have another 23 hours, 59 minutes and 50 seconds to enjoy from the rest of the day that is not about HIV. Part of that involves some good quality sleep, we concur, but there are still many hours to enjoy in the rest of the day!
2) Drug Interactions
Drug resistance can also develop due to DRUG INTERACTIONS – which is when the HIV drug levels are affected (causing a decrease in the amount or concentration of drug in your body) by another drug you are taking – this can include over the counter non-prescription drugs (that you have purchased yourself) as well as prescribed drugs.
Generally, however, your doctor will NOT prescribe a treatment that may interact with your HIV treatments, but this can sometimes occur if you have more than one doctor where each doctor does not know about treatments you may be on as prescribed by another doctor.
That is why it is important to tell any doctor if you are on HIV medications as it will influence the type of other drugs that can be prescribed to you. Some HIV drugs interact more than other HIV drugs with other medicines. Your HIV pharmacist also needs to know what other drugs you are taking other than HIV treatments, for this same reason.
You should tell your doctor and pharmacist about every treatment you are currently taking or may take – this also includes any medicines, herbs, or supplements you buy without a script off the chemist store, supermarket, or health-food store shelves.
It is also important to know that drugs interactions can also be the reason that treatment side effect occur, because the amount of drug levels in your body can be associated with the emergence of side effects.
For further information on HIV drug interactions, including an interactive database as well as a useful App for your iPhone or iPad or other mobile device, please visit HIV Drug Interactions’ website.
Transmission of drug-resistant HIV does occur
The main factor driving this is the lack of proper adherence to treatment (which generates drugs resistance within the person living with HIV).
Whilst transmission of drug resistant virus occurs, it is usual only “partial resistance” which does not automatically mean that none of the available HIV drugs won’t work. More so, they may only work less optimally but still have some activity against HIV – but this situation may require more complex treatment regimens (i.e. the number of HIV drugs required may increase beyond the standard 3 drug regimen).
However, there have been next to no cases where none of the HIV drugs will work. Rarely has anyone run out of HIV treatment options these days (which is good news!).
The gradual increase in transmitted HIV drug resistance has been a pivotal factor why HIV doctors now test for drug resistance before someone first starts HIV treatment – to make sure that the HIV treatments that are being considered to be used will work optimally to supress HIV to undetectable levels (which is the goal of HIV treatment). This test for resistance is called the Genotypic Resistance Assay (GRA).
Recent news on drug resistance can be found on Aidsmeds website.
If you have any questions about HIV treatment, please call QPP’s Health Promotion and Treatments Officer toll free from a land-line on 1800 636 241, use the contact form provided or call (07) 3013 5555 (nationally).