Antiviral Strategies

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After the decision to start treatment has been made, it is important to clarify your treatment regimen with your physician. Knowing what medications you are taking and why will help to better
understand the importance of adherence. One survey indicated
that the vast majority of people were unclear of their treatment
regimen only ten minutes after consulting with their physician.
Some people understood the dosage but were confused about dietary restrictions. Others were unclear on the correct dosage or
the timing of the doses. Since dietary adjustment can be a difficult at first, it is important to know what and when you can and
cannot eat. Just as important, try to understand exactly what is
meant by the dietary requirements. For example, many people
interpret the requirements for indinavir (Crixivan) as saying that
the drug should not be taken with food, which can be difficult for
many people. The actual dietary requirement is that it shouldn't
be taken with fatty foods. Light snacks and non-fat foods can be
taken with the drug without concern. Similarly, the requirements
for nelfinavir (Viracept) are often interpreted as meaning that it
must be taken with food, when in fact the label says only that it
should be taken with food. In some cases, there is a genuine medical
need to take a drug with or without food, while in other cases,
such as the use of ritonavir (Norvir), use with foods is recommended only to minimize side effects or unpleasant aftertaste.
A useful technique for understanding a treatment regimen is writing down instructions and repeating them back to the care provider, then checking them again with a pharmacist when you pick
up or order the drugs. Use the team approach; your physician,
nurse, pharmacist and other health care providers can all be helpful with initiating and supporting effective therapy. Researchers
CAPS have noted that people who actively foster a friendly and
supportive relationship with medical office staff get better service
from their providers. Bringing another person (family member
or friend) to appointments ensures that there are two people to
ask questions and get information.
Ask the doctor to be clear about side effects andtheir management. Being mentally prepared for side effects can make them
easier to manage if they occur. Make an agreement with your care
provider as to what the process will be if you experience a difficult
side effect. Knowing that you will have timely contact with a provider may reassure you that side effects will be managed efficiently.
It is also important to find out from your physician what to do if
you miss a dose. If you do miss a dose, find out if you should make
it up a or just take the next one. Also, note the missed dose and
the reason for missing. There may be a strategy you can use to
avoid missing future doses. If you are not able to take all the drugs
in your combination, don't take a partial dose. Contact your care
provider immediately. If necessary, stop all of the drugs in your
combination therapy until you are able to take a complete dose again.

N
Adherence to HAART J
Discussion Paper
Commitment
At the initiation of therapy, most people question what "adherence" means. It is important to keep an adequate level of drug in
your blood stream 24 hours a day in order to prevent the development of resistance. Each time a dose is missed, the blood level of
the antiviral drugs falls below the minimal necessary amount for
several hours, creating a temporary opportunity for the selection
and growth of drug-resistant strains of virus. There are no data
telling us exactly when resistance to drugs begins but there is
plenty of evidence that people who are adherent to their treatment regimens have a better and more sustained antiviral response. While no single episode of a skipped or late dose is likely,
by itself, to trigger resistance, the more often such episodes occur, the more likely resistance becomes.
Strategies for Adherence
Some of the following strategies and tools have worked for many
people taking triple combination therapy:
Integrating your treatment regimen into your daily routines. Most people find it easier to fit their medications into
their lives, rather than scheduling their lives around their
medication. Use a daily activity, one that you do every day
without fail, to prompt you to take medications. Take your
medications before the activity; it's easier to remember.
Counting out all your medications in daily doses for a week
at a time. Use a pill box or a nail organizer from a hardware
store to hold each dose. Setting up the weekly pillbox must
become a routine weekend duty. Medications can also be divided daily by dose and put in separate canisters (some people
use film canisters) marked with the dosage times. Some people
put each canister near the place they will take a dose. For
example, put the morning dose by the coffee pot, evening by
the television set. This is more difficult with drugs that require refrigeration.
Keeping a checklist for doses taken with a space to note how
you are feeling.
Using an electronic pill box or beeping alarm to remind
you when to take medications. The downside of these mechariisms is that the currently available electronic pill boxes are
too small and the alarms may be too obvious.
Using a daily planner, especially at the start of a new treatment regimen. Inserting medication requirements in a planner, as if they were appointments, can be a useful reminder
for many people. Others use hand-held computers and inexpensive electronic organizers with scheduling functions to
remind themselves of their daily medication needs. Electronic
devices of this type can be purchased for less than $50 dollars.

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