For those on PrEP, how good are you about adherence?

[wood]

Just as the question states. Just trying to get a good idea about what other people are doing.

For myself I have never missed a day, but had had a variance in terms of time of day up to about 7 hours on one occasion. In my case, would there be any significant impact on efficacy because of that?

[rawTOP]

I miss a day, sometimes two, every month. And occasionally I don't realize I didn't take it until 8-12 hours after I usually take it. I've been taking hypertension meds for almost a decade now - so it fits nicely into that routine.

Those of us on PrEP aren't poz. We're not controlling a virus that's in our body. For us it's just about having enough of it in our system when we happen to encounter HIV. So relax if you're a few hours late. The half-life of the meds is fairly long.

The infections they saw in the trials were largely people who didn't have the meds in their system when they came in and tested poz. That means they were off the meds for a week or two.

So be religious about it, but don't be neurotic about it.

[bearbandit]

While I'm aware that the half life of many ARVs is longer than the manufacturers state, I'd strongly recommend that you stick to the adherence patterns that are recommended for PwHIV, which basically means a two to four hour window. If your normal time is 10pm, you can take it after eight and before midnight. I recognise that it might be harder to keep to a routine when it's "in case", rather than essential. Try tieing your medication time to a daily life event: I rarely miss taking my ARVs (raltegravir is still a twice a day med) because I take them at the same time as my diabetes medication, and if I don't take that I feel like shit. Try setting up an alarm on your mobile phone, anything, just don't miss a dose. Please.

[wood]

While I'm aware that the half life of many ARVs is longer than the manufacturers state, I'd strongly recommend that you stick to the adherence patterns that are recommended for PwHIV, which basically means a two to four hour window. If your normal time is 10pm, you can take it after eight and before midnight. I recognise that it might be harder to keep to a routine when it's "in case", rather than essential. Try tieing your medication time to a daily life event: I rarely miss taking my ARVs (raltegravir is still a twice a day med) because I take them at the same time as my diabetes medication, and if I don't take that I feel like shit. Try setting up an alarm on your mobile phone, anything, just don't miss a dose. Please.

Yeah that's what I've been doing. My thing is, if I'm going to do this, I'm going to do it right, and I want maximum effectiveness. There has only been two instances in two months where it has been more than a 4 hours difference from the day before so I think im doing pretty well.

[Guest JizzDumpWI]

I am very compliant in adherence to the schedule. I'm up pretty much the same time every day. Take my Truvada around 6:30am. I might vary occasionally by an hour, maybe two; that's the extent of it.

When my ID doc and I were discussing, he was pretty comfortable if I was quite late on one dose a month. I'm imagining that if I missed one dose a month and were not my currently whorish self, i would be fine. Lately I'm blessed with one or more loads per day; so compliance is crucial in my opinion to remain HIV neg.

Now, my whorish ways might lead to an STI. If between quarterly checks I ever have reason to believe I have an STI; I won't hesitate to go to my clinic. But my batting average for STI's is about one every 30 months.

[Guest JizzDumpWI]

Yeah that's what I've been doing. My thing is, if I'm going to do this, I'm going to do it right, and I want maximum effectiveness. There has only been two instances in two months where it has been more than a 4 hours difference from the day before so I think im doing pretty well.

If I am to believe my ID doc, that is an acceptable metric. I agree, in for a dime, in for a dollar right?

[rawTOP]

While I'm aware that the half life of many ARVs is longer than the manufacturers state, I'd strongly recommend that you stick to the adherence patterns that are recommended for PwHIV, which basically means a two to four hour window. If your normal time is 10pm, you can take it after eight and before midnight. I recognise that it might be harder to keep to a routine when it's "in case", rather than essential. Try tieing your medication time to a daily life event: I rarely miss taking my ARVs (raltegravir is still a twice a day med) because I take them at the same time as my diabetes medication, and if I don't take that I feel like shit. Try setting up an alarm on your mobile phone, anything, just don't miss a dose. Please.

PwHIV = Persons with HIV?

I do what you're talking about - I take my Truvada when I get myself ready in the morning - it's in the medicine cabinet next to the shit I put in my hair.

I've been on a variety of other meds over the years - anti-seizure meds (that I didn't need), hypertension meds, etc. With those others it was always "don't miss a dose, but if you do take it as soon as you think about it unless it's the next day." I don't see why I would need to be more vigilant than that with PrEP.

Not sure how many times I have to repeat this, but PrEP is not being used to manage an active infection. If look at the studies it's probably nearly as effective if taken 5 days a week provided the two off days aren't consecutive. I've talked to my doc about all this and he agrees with me. And I should give the caveat that he's at a gay health clinic that cares very much about getting PrEP right.

There's no need for guys on PrEP to be neurotic about their meds. They just can't be cavalier about them.

[Guest JizzDumpWI]

There's no need for guys on PrEP to be neurotic about their meds. They just can't be cavalier about them.

rawTOP, I definitely agree in principle. The problem with 3 on, 1 off, 2 on, 1 off is that it more often than not degrades into less than that. Hence daily compliance makes more sense. But to your statement; no need to be neurotic, just don't be cavalier, indeed.

[bearbandit]

PwHIV = Persons with HIV?

Yep

Not sure how many times I have to repeat this, but PrEP is not being used to manage an active infection.

I really and truly understand where you're coming from on this, and probably agree with you much more than you think. But the problems we've had with adherence amongst PwHIV, where, yes, that adherence is probably more of an issue, is the difficulty in maintaining adherence. I think you guys taking PrEP are doing yourselves a disservice by thinking you can skip the odd dose. As JizzDump points out, it's easy enough for one missed dose to become two - hell, I've done it and I know my life depends on these drugs. Blips, whether they're unexpected infection or unexpected rises in viral load, do get back to the drug companies concerned. I want you guys to have the freedom to fuck as and when it suits you (being totally selfish!) - what I don't want is to find you sitting next to me in the queue at the HIV clinic.