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 as prescribed by a health care provider or recommended by a pharmacist.


To keep viral loads 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 immune system damage, disease progression and HIV transmission. Poor adherence can also cause drug resistance, meaning meds may stop working. With PrEP, inconsistent use raises the risk of HIV acquisition.


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 or 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. Many modern regimens require just one pill once daily with few or no food requirements. In addition, there are now long-acting injectable antiretrovirals that can be taken once monthly or less often. 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 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? 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, case manager or an AIDS service organization about health insurance options and payment assistance programs.


Lapses in treatment adherence can happen to anyone. Don’t feel bad or guilty if you sometimes miss a dose, but do resolve to do better for the sake of your health and well-being.


Adherence Tips

  • Make it a habit. Keep meds next to something you use every day, like your coffeepot or toothbrush.
  • Beware of schedule changes. Some people have more trouble remembering their meds on days off from work or school or during a vacation.
  • Meds on the go. If you need to take your medications while outside the house, check out portable pill cases—some even have built-in timers.
  • Travel smart. Keep your meds in carry-on luggage and bring extra doses in case of flight delays or other unexpected events.
  • Plan ahead. Regularly refill your prescriptions so you don’t run out.