Studies have shown that combination HIV treatments work best when they are taken on time, and at the right dose. This is because the drugs work as a chemical barrier in your body, stopping HIV from infecting cells and making more virus. However, drugs don't stay in your body forever—they are gotten rid of the same way as other things you swallow, through the digestive system, the kidneys and the liver. Some drugs are gotten rid of very quickly, so they have to be taken more than once a day to keep enough in your body to stop HIV.

If high enough levels of drug aren't kept up, HIV gets the chance to make more copies of itself. When HIV reproduces, the new virus that gets made is often a little different from the "parent" virus. These differences are called mutations. Mutations can change the parts of the virus (like the protease enzyme, for example) that the anti-HIV drugs are meant to block. If this happens, the drug will no longer work and you may need to find a whole new anti-HIV drug combination to use. This is why adherence – taking your medications the right way – is very important for getting the best out of the available HIV drugs.

Keeping up adherence to treatment isn't always easy. Most anti-HIV drug combinations use three or more drugs, each taken two or three times a day (sometimes on specific schedules such as every 8 hours). Each drug can also have different rules about food—some work better on a full stomach, while others need an empty stomach to be properly absorbed. The protease inhibitors ritonavir (Norvir) and saquinavir (Fortovase) have specific storage requirements that involve refrigeration. All drugs can also cause side effects, adding to the problem of taking them regularly.

When you're thinking about starting anti-HIV treatment, it's important to learn about what side effects to watch for, and how you may be able to reduce them. For example, the protease inhibitor nelfinavir (Viracept) often causes diarrhea. Some people have found that certain foods, like bananas and rice, help reduce or stop this diarrhea and make the drug easier to take. Prescription antidiarrheal drugs can also help if food strategies don't work. Knowing this kind of information before starting a drug helps you deal with side effects and reduces the chance that you'll have to stop or interrupt treatment. The Network has free Simple Facts Sheets on each available anti-HIV drug and their potential side effects.

It's also important to be clear about the dose, time schedule and food requirements of each drug you're taking. Making up a daily schedule with this information can be extremely helpful, as this becomes your personalized treatment plan. Another good tip is planning this schedule around things that you do regularly each day. Examples might be getting up, going to bed, watching certain TV programs, cooking and eating meals, daily exercise, picking up or dropping off a child from school, etc. It can be a helpful reminder to put your meds where you know you'll see them at a certain time of day, like in the kitchen, on top of the TV, etc. (that this can't always be done if the drug needs refrigeration). When you know that your routine is going to change (at the weekend or because of a vacation, for example) planning ahead can help avoid interrupting your HIV treatment.

There are also many products designed to help with adherence. Pill containers with separate boxes for each daily dose are available, some with room for a whole week's worth of medications. There are also various electronic beepers and alarm watches which some people report finding helpful. The Government's guidelines on the use of anti-HIV drugs clearly say that the decision to start anti-HIV treatment is not just based on your bloodwork. At least as important is your own readiness to start a potentially complicated drug combination and try and stick with it. Unless there is a serious medical reason, no one should put pressure on you to start HIV treatment until you feel ready. You can always call us at the Network for additional drug information and referrals.

Stopping treatment. There can be many reasons why you might have to temporarily stop an anti-HIV drug combination, including side effects or simply forgetting to take the drugs with you when travelling. Treatment guidelines state that if a combination is working well and you need to stop, you should stop taking all the anti-HIV drugs at the same time. Studies have shown that the same combination will most likely work again when you restart. There is one possible exception to the "stop all anti-HIV drugs at once" rule—the drugs nevirapine (Viramune) and efavirenz (Sustiva). If one of these drugs is part of your combination (or cocktail), some doctors recommend stopping the Viramune or Sustiva a day or two before you stop the other anti-HIV drugs (such as stavudine (d4T, Zerit) or zidovudine (AZT, Retrovir) for example) that you are taking.

There are many factors that can make it harder to stick with a treatment plan. Depression and stress can affect your ability to carry out your daily tasks, including taking medications. Alcohol and illicit drugs can affect judgement and memory, and in some cases may react badly with HIV drugs, causing dangerous toxicity. Being at work can complicate the task of taking medications due to confidentiality problems and/or unpredictable daily schedules. Getting support to help deal with these kinds of issues is important, and talking to your provider, case manager and/or local community-based organization can be a good place to start.