HIV

HIV treatment requires you to take medicines every single day. Sounds straightforward, but this usually is easier said than done! Let's examine why medication "adherence" is so important for people living with HIV and discuss some tips for taking your medicines every day.

A slippery slope

HIV may seem a lot like diabetes or high blood pressure. All of them are chronic diseases that are managed with daily medications. However, providers seem to worry more when patients miss doses of their HIV drugs compared with other medicines. Why is this?

When you miss taking your diabetes or high blood pressure medicines, your blood sugar and blood pressure go up. When you restart the medicines, they go back down again. It's generally not good for your body to go through those kinds of ups and downs, so it is best to take high blood pressure and diabetes medicines every day.

HIV medicines are a little different because they fight a virus that is living inside you. When you forget to take your HIV treatments, the virus makes copies of itself very quickly. Some of the copies end up with slight changes that help the virus resist HIV drugs. These mutated viruses can remain alive even when you put HIV drug back into your bloodstream. This is known as resistance. If you take your HIV drugs every day and your viral load is undetectable, the virus is not making copies of itself, and there is little chance of developing resistance.

We now have many more HIV drugs than we did in the past. However, when you don't adhere to your regimen and your virus develops resistance, you may have to take more pills, more frequently (for example, twice a day instead of once a day), or may have to try treatments that have new or different side effects. Developing resistance also means that your choices for the future are more limited.

The nitty-gritty practice of adherence

Most people don't want to miss doses of their medicines, but it can be a challenge to remember them every day. Here are some practical tips for remembering to take your medicines:

• Make sure you have enough: Contact your VA or other pharmacy for a refill when you still have a 1-week supply, so that you don't run out. Talk to your pharmacist about programs to help you get your medicines on time, such as automatic refills. Remember to ask for refills at every clinic visit.
• Develop good habits: Try keeping your pills in one location, so that you know where to find them. You can keep them in a place where you will see them frequently. You can also try taking your medicines at the same time as you do something else, such as brushing your teeth. Since you don't forget to brush your teeth, you can place your medicines near your toothbrush, so that you remember to take them every day.
• Set up reminders: You can set an alarm on your cell phone to help remind you to take your medicines. Weekly pill boxes can also be helpful. If the day's slot is empty, then you know you already took your medicines. If it is still full, you know that you haven't taken them yet.
• Stash pills away for emergencies: It may be helpful to have an "emergency dose" of medicine with you at all times. If you travel a lot, you may want to keep a few extra doses in your suitcase. If you carry a bag or a purse, you can keep a few spare doses there. There are special key chains you can purchase that store medicines. Having extra doses can help if you forget to bring your medicine when you are away from home or if you accidentally forget to take your dose before leaving.

The bigger picture

Poor habits or lack of a routine are not the only reasons people miss doses of their medicines. You may find yourself hesitating to take your medicines for many other reasons. Perhaps you are afraid of side effects. You may not want to take them because they remind you that you have a chronic disease. Or you may simply be tired of taking pills every day. If one or more of these thoughts are standing in the way of you taking your medicines regularly, you may want to try one of the following:

• Talk with your provider: Be honest about how you are feeling. This is especially important if you are experiencing side effects that stop you from taking your medicine. Your provider may switch your medicines, or give you tips on how to combat side effects.
• Find your inspiration: After you've been taking pills for a while, it is easy to forget why you started taking them in the first place. What inspired you to start HIV treatment? What were you hoping would happen when you started taking the medicine? Reminding yourself of these things can sometimes help keep you motivated to take your pills.
• Find your support system: Taking pills every day can be a lonely task. It sometimes helps to rally a partner or a group of people who can be your supporters when you don't feel like taking your medicine. These "medicine cheerleaders" can check in on you, encourage you, and listen to you. If you have one or more supporters that can do this, be sure to talk with them about the ways they can help you stay motivated.

Sticking to your treatment is hard work, but the payoff is high: you'll be able to watch your immune system get stronger and your viral load stay low. Keeping HIV under control with the use of powerful drugs and adhering carefully to the regimen is the best way to ensure a long and healthy life.