HOW MUCH ADHERENCE IS ENOUGH - AIDS Fact sheet

Adherence means taking your medications correctly. If you don't, HIV might multiply out of control. Several research studies have measured how much adherence is "enough." They found that, for the best viral load results, people had to take nearly 100% of their pills correctly. The fewer doses you miss, the better the chances of keeping HIV under control.

HOW DO AIDS DRUGS WORK?
The HIV virus can make millions of copies of itself every day. Antiretroviral drugs can't kill the virus, but they can almost stop it from multiplying.

A "viral load" test measures the amount of virus in your blood. If you take anti-HIV drugs, the amount of virus in your blood should go down. If your viral load is very low, you probably won't develop any AIDS-related illnesses.

WHAT IS RESISTANCE?
The HIV virus is sloppy when it makes copies of itself. Many new copies of HIV are slightly different from the original (mutations). Some mutations can multiply easily even though you are taking drugs that stop "normal" HIV. This is called "developing resistance" to the drugs. If your virus develops resistance, it will multiply faster and your HIV disease will probably get worse.

Resistance develops quickly if you take just one drug. If you take three drugs, HIV multiplies much more slowly and it is much harder for resistance to develop.

Sometimes, when HIV becomes resistant to a drug you are taking, it will also be resistant to other antiviral drugs - even if you haven't used them yet. This is called "cross-resistance". Many HIV drugs are at least partly cross-resistant. If your virus develops resistance to an HIV drug, you might not be able to use any other drugs of the same type. To avoid using up your treatment options, take all of your medications according to instructions.

KEEPING PRESSURE ON THE VIRUS
When you take medications, they get into your blood and are carried around your body. Then your liver and kidneys start to clean the drug out of your system, and the amount of medication in your blood goes down.

Some drugs get into your bloodstream better if there is no food in your stomach. You take these medications on an empty stomach. Other drugs get into your bloodstream better if your stomach is full. You should take these drugs with food. With some drugs, food doesn't matter.

The instructions for taking each drug tell you how many pills to take, when to take them, and how to take them, in order to keep enough medicine in your blood. If you skip a dose, reduce your dose, or don't follow the eating instructions, the drug levels in your blood will drop.

If there is not enough medicine in your blood, HIV can continue to multiply. The more HIV multiplies, the greater the chance that resistance will develop.

The best way to keep pressure on HIV is to take all the pills you're supposed to, every time you're supposed to, and follow the directions about food.

MAKE IT EASY ON YOURSELF
It can be difficult to take your medications the way you're supposed to. Make it as easy as you can!

• Tell your doctor about your daily schedule so that you can choose the medications that will be easiest for you to take.
• Make sure you understand your medications:
  • Which medications to take
  • How many pills to take, and how many times a day
  • Whether to take your pills with food, or on an empty stomach
  • How to store your pills
  • Side effects you might have, and what to do about them
• Plan ahead for refills or tips so you don't run out of any medications.
• Use a pillbox and count your pills out ahead of time. Some boxes hold enough for a week or two.
• Set a timer or alarm to go off when you have to take pills.
• Choose a regular daily activity to help you remember to take pills:
  • Making your morning coffee
  • Getting out of bed
  • A favorite TV show
  • Coming home from work
• Make sure your family members know how important it is for you to take your pills. Ask them to help you remember.