Michael@neolithicrumba2
Here’s the long answer:
Most of us are taking drugs that are prescribed as one pill a day, not one pill every 24 hours exactly.
Our doctors want us to take it at the same time so we create a habit and are less likely to miss.
Dosing is based on clinical trial data. A pharmaceutical company will get a few people, say 10-12 subjects, put them in a hospital setting, and give them one pill. They then draw their blood every few hours to determing the drug’s half life, or how long it remains in the bloodstream.
That’s why some pills are dosed 2X a day, every 8 hours, once a day, and with new drugs being tested, once a week.
But if you think about it, ARVs in blood doesn’t stop HIV replication. The drug needs to get inside a CD4 cell to stop replication from the inside. Drug levels inside cells will slowly build up over days, so it may take a week before our CD4s are fully saturated. This means that it can take just as long for the drugs to go down if we stop our meds.
A French study looked at people who were virally suppressed for 6 months on different ARVs and gave them the option to take their pills for four days with three days off. Compared to people who take their daily pill, viral suppression was about the same. These folks had frequent viral load testing, so if the 4 on, 3 off stopped working, they could start daily dosing right away.
This study tells us that missing a dose isn’t the end of the world. In fact, when clinical trials happen, “perfect” dosing is considered 95% or better. That means you can miss one pill a month and still be perfect.
Personally, I find it more helpful to tie our pill taking to some other daily activity, like morning coffee or brushing your teeth before bed. We don’t forget these other things, and we don’t unecessarily stress ourselves out when we do ❤️