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HIV and AIDS

Sticking to It: An HIV Patient Discusses Adherence

Summary & Participants

As a pharmacist, Brian Peiper knows about the importance of drug adherence. As a patient, he knows it's not always easy. Tune in as he shares his experience and advice from both sides of the counter.

Medically Reviewed On: July 17, 2008

Webcast Transcript

BRIAN PEIPER, RPh: Not only do I manage the pharmacy here, but I'm also a client here, since I am also HIV-positive. Ninety nine percent of my clientele is HIV-positive, and I deal with them and I know all about their problems, because not only am I their pharmacist, but ultimately I become their therapist also, and I hear about all their aches and pains and moans and groans, complaints. It kind of makes me thankful that I've been health for the past four years, and that's how long it's been since I've known that I'm HIV-positive.

I did not start treatment right away. I kind of held off being a pharmacist. I'm acutely aware of the side effects that come hand in hand with therapy, with medication therapy, and I did not want to subject myself to that.

My initial therapy consisted of Epivir, Zerit, Norvir, and Invirase. I'm fully aware of the fact that, especially with the protease inhibitors, you need to give about a month for the side effects to subside if you do get any side effects. Probably within a month after starting the therapy, I just couldn't handle any more. I was standing at work one day, and I was tired of suffering the headaches and the numbness of the mouth, the tingling, the diarrhea. I called my physician and changed my therapy and he took me off the two protease inhibitors right then and there and switched me over to a different combination.

Looking back on it, it was quite an educational experience for me, with my changes in my therapies. Not only was I dealing with my own issues of how many times a day I had to take medication and whether I needed to take it with food or not, but in dealing with my patients every day, I hear what they go through, and it really made me relate to them a lot, and literally it helped me explain things to them quite easily.

Do you want me to give them the Prevacid and DC? The Prilosec?

Adherence is the key to a successful drug regimen. If a person is willing to take their medications as prescribed every day, then they're more likely to keep the viral levels down in their body and have a more successful therapy. Any time anybody slips up -- and people do slip up. I slip up. There have been times where I've missed a dose myself, and sometimes things happen where you just can't help it. I've had several patients come into my pharmacy that have had various and sundry issues with taking the medications that have been prescribed for them. They need to try the medication first if they haven't ever been on it before. They need to try it first, see if it'll work. Not everybody will experience the same side effects from the same medication. Not everybody will experience side effects at all. You really need to try it and see what happens.

There are different tools that can be used. I have dosing boxes, pill boxes that are split up into seven days. Some have three, sometimes four compartments per day. There are charts. There are cards that can be carried in your wallet, on your person, that have all your specific drug regimens written down and what you're supposed to take and when you're supposed to take it. There are beepers available that can go off at various times that you can preset to remind you to take your medication. You can have a friend call you. If you've got a friend that's that close to you and dear to you, that cares about you that much, they can call you and say, "It's time to take your pills."

A lot of my patients ask me the question whether taking medications in once-a-day dosing or twice-a-day dosing is better than multiple dosing during the day, and I tell them usually it is. The less pills you have to take during any kind of therapy, the more apt a patient is to maintain that therapy.

In my pharmacy practice, I do get a lot of questions from my clients regarding whether they should take their HIV medications with food or without food, and that's a very good question. A lot of the medications do have dietary restrictions. Some need to be taken on a completely empty stomach. Some need to be taken on a full stomach. Some need to be taken with a high-fat meal.

I try to empower my patients and try to get them to realize that they do have the power within them to beat this thing, and if they can take their medications, which is of utmost importance, if they can take their medications at the prescribed times every single day and try to miss as little of the doses as they possibly can, then they're definitely going to ensure the success of their drug therapies and be around a lot longer. That's the basic rule that I live by in my own living. I do what I need to do, and I tell them that they need to do what they need to do, just to make sure that they'll be around for lots of years to come.