“Adhering” to your treatment schedule — which means taking your medications just as your doctor prescribed them — is very important if you want your meds to work. If you miss a dose or don’t take your meds as instructed (for example, with or without food), the level of medicine in your blood will be lower than it should be. Over time, this may allow the virus to become “resistant” to one or more of your HIV drugs, which means that drug can no longer fight your HIV. Resistance to one medication may mean that similar HIV meds won’t work for you later on. Since there are only a few choices for treatment, losing options will make it harder to fight your HIV. So don’t risk missing a dose by blacking out or sharing your meds or selling them to someone else.

If your HIV is resistant to a certain drug and you infect someone else, their HIV will be resistant to that medicine too, even if they’ve never taken it! That’s why it is important to practice safer sex and safer drug use with everyone, even HIV+ partners.

Adherence & resistance

Talk with your doctor about adherence before you start taking HIV meds so he or she can help you pick a schedule that suits your life. If you feel like you’re ready to stick to a schedule, tell your doctor. Your doctor does not have the right to refuse you HIV treatment because you use drugs or to force you to stop using.

Here are some tips that might make it easier for you to stick to your treatment schedule:

• Know why you’re taking HIV treatment — talk with your doctor about how your HIV medicines work and why it’s important to take them as prescribed and instructed. The more you understand your treatment, the more likely you are to stick to your schedule.
• Learn exactly when you have to take your meds — ask your doctor for details: How many pills will I take each day? Do they have to be taken with food? What kind of food? Do I have to refrigerate my meds? What if I miss a dose? Ask your doctor to write down exactly what you have to do.
• Figure out what might prevent you from sticking to the schedule — maybe you don’t have a fridge to store your meds in, or a place to stay. When you’re using drugs, you may forget to take your meds or you may not feel like eating. Talk with your doctor about any obstacles — and what you can do to make adherence easier. Your doctor may be able to suggest a simpler treatment option, or you could try to change your drug-using schedule.
• Ask about side effects — being aware of possible side effects will make it easier for you to deal with them if they occur. If you experience side effects, talk with your doctor before stopping any treatments. Your doctor can adjust your meds or help you find ways to keep the side effects under control.
• Get some help you can count on — support from friends, family or a partner can help you take your meds on schedule. Ask someone to remind you when it’s time to pop your pills. Your doctor, nurse or AIDS agency may be able to match you with a “buddy” — someone who also has HIV, uses drugs and is taking HIV treatment.
• Use reminder gadgets — these may help you get into a routine. Get a special pill box that will help you organize your meds for the whole day or week. Carry a couple of doses with you when you go out or stash extra doses at the places you regularly go to during the day (such as the needle exchange or methadone clinic). Or get a key chain with a beeper or a digital watch with an alarm.
• If you have problems, call your doctor, nurse or pharmacist — sometimes people feel like they’ve done something wrong by missing doses, and they keep it a secret. But if you don’t tell anybody, you can’t fix the problem.

Whatever you do, don’t stop taking your HIV treatments unless you’ve talked with your doctor. If you do miss a dose of your medicine by more than 2 hours, wait until it’s time for your next dose and go back to your normal schedule. Don’t take an extra dose to make up for the one you missed.

Drug interactions

If you take HIV medicines and you’re using drugs, drinking alcohol regularly or taking methadone, you need to know that sometimes these substances interact with each other. It can work both ways: Certain drugs can make your HIV meds less effective. Or your HIV meds can make you have a bad trip on some drugs. Even worse, some HIV meds can increase the level of drugs or alcohol in your blood so much that you could overdose. This is why it’s so important to tell your doctor about all the drugs you are taking.

Here are some steps you can take to reduce the risk of having a bad drug interaction:

• Talk with your doctor or a pharmacist about all the drugs you take, including methadone. He or she should be able to give you information about any potential drug interactions. Your doctor may recommend changing your HIV treatment to avoid problems.
• Consider switching to drugs that appear to be safe with HIV treatment, such as marijuana.
• If you do use drugs after you begin HIV treatment, start slowly. Just half of your usual hit may have the same effect that the full hit used to have. Take a smaller dose of your drug. Wait to see how you feel and how it affects you. Take more only if you need it.
• Some HIV meds decrease the strength of methadone, which means you could go into methadone withdrawal. Check whether your methadone dose needs to be adjusted.
• Though not a lot is known about how HIV meds interact with drugs, alcohol or methadone, it’s a good idea to talk with your doctor, nurse or pharmacist about what is known so you can stay as healthy as possible. Also, ask other people with HIV who use drugs about their experiences, and carefully monitor your own.

For more info about interactions between HIV meds and any other drugs (including heroin, methadone, antidepressants and birth control pills), ask your doctor or pharmacist.