All modern antiretroviral regimens are highly effective and generally well tolerated, so treatment success often comes down to consistent use. Regular use is also a key to effective pre-exposure prophylaxis (PrEP). Adherence means taking the correct dose of medications every time, exactly as prescribed by a health care provider or recommended by a pharmacist.
People who feel that they are benefiting from their medications may have an easier time taking them consistently. Understanding how antiretrovirals work can help with adherence.
To keep viral load suppressed, the concentration of antiretrovirals in the body must be kept at a high enough level. If drug levels fall too low, the virus can resume replication, which can lead to disease progression. People who maintain an undetectable viral load can usually avoid immune system damage and reduce the likelihood of HIV-related complications. What’s more, they do not transmit the virus via sex (Undetectable = Untransmittable). In addition, poor adherence can result in drug resistance, which can cause meds to stop working and may limit future treatment options. Taking a daily prevention pill dramatically reduces the risk of HIV acquisition, though some people can take PrEP “on demand” before and after sex.
But taking pills every day is not always easy. Some people have difficulty remembering to take their meds, or they don’t want to think about having HIV every day. Drug and alcohol use, depression and other mental health issues can interfere with good adherence. Concerns about side effects can make people reluctant to stick to their treatment. Some people are worried about having pill bottles that could reveal their HIV status, or they may be in situations where their meds could be lost or stolen. Finally, if the cost of medications is a concern, people may be tempted to take them less often to stretch their prescriptions.
Antiretroviral treatment and biomedical prevention have come a long way in recent decades. Most people living with HIV no longer need to take multiple pills more than once a day. Many modern regimens require just one pill once daily with few or no food requirements. What’s more, some newer antiretrovirals are considered more “forgiving” if you occasionally miss a dose.
In addition, there are now long-acting injectable antiretrovirals that can be taken once monthly or less. Cabenuva (injectable cabotegravir and rilpivirine) is administered by a health care provider once monthly or every other month. Apretude (injectable cabotegravir alone) is used for PrEP every other month. Sunlenca (lenacapavir) is administered by injection every six months for treatment-experienced people with multidrug-resistant HIV, but it currently must be used in combination with daily pills. Sunlenca is also being tested for first-time treatment and twice-yearly PrEP.
Some people find it more convenient to take a pill every day, while others would rather visit a clinic periodically for a shot. Having more options available makes it easier for everyone to find an HIV treatment or prevention regimen that works for them.
When starting treatment for the first time or switching to a new regimen, consider whether your lifestyle poses any potential obstacles to good adherence. For example, do you eat meals and go to bed at a consistent time? What other medications are you taking?
If you’re using a combination that requires multiple pills or more frequent dosing, ask your doctor whether a simpler regimen might be right for you. Talk to your health care provider if you are struggling with drug side effects, substance use or mental health issues. If you’re having trouble affording your medications, talk to your doctor or a case manager about health insurance options and payment assistance programs. Finding other people in your situation can also help. Join a support group, or connect with other people living with HIV in the POZ Forums.
Lapses in treatment adherence can happen to anyone. Don’t feel bad or guilty if you sometimes miss a dose but resolve to do better for the sake of your health and well-being.
Tips for Improving Adherence
- Make it a habit. Keep your antiretrovirals near something you use every day, like your coffeepot or toothbrush.
- Beware of schedule changes. Some people have more trouble remembering to take their meds on days off from work or school, during vacations or at other times when their schedule is different from usual.
- Set up reminders. Some AIDS service organizations and pharmacies will call or text to remind you to take your medications. Online reminder services can also send you messages at specified times.
- Set an alarm. Program your watch or phone to alert you at the times of day when you need to take medications.
- Meds on the go. If you need to take your medications while outside the house, check out portable pocket-sized pill cases—some even have built-in timers.
- Travel smart. Keep with your meds in carry-on luggage and bring extra doses in case of flight delays, cancellations or other unexpected events.
- Plan ahead. Make sure to regularly refill your prescriptions so you don’t run out of your medications.
Last Reviewed: March 27, 2024
