Letter Sender 3: ARVs and Travelling

Hello guys! 

It's been a while. I haven't checked my mail in what feels like eternity and am quite surprised to see a few messages from blog readers. One of them came from a reader from Malaysia, and here is his message:

"Hi thr. I come across ur blog while researching for upcoming trip. 

Am plhiv from kl. Malaysia. On haart since sept last year. Currently cd4 above 500 n vl undetectable.

I need to travel to swirtzeland on end of nov. Am not worry about immigration or anything. Just i need your advice since am on combivir and efavrinze cocktail.

Combivir for twice a day 8 am 8 pm. And efavirenz at 11 30 pm. When i am bout to go to bed.

My question is when u travel. Do u take med according time of ur origin country i e malaysia. 
If i follow time in msia i need to take the med on 2 am 2pm and 5.30 pm swiss time. 

It will be bit difficult since u know efavirenz can makes one bit drowsy n sleepy. 

One doc suggest if u travel less than 2 weeks just follow malaysia time. Some senior plhiv said if u healthy n stable just follow swiss time. He has been doing it for so many times n ok.

But am afraid about interruption on meds since willl b pn board for almost 16 hrs. 

Any ideas. Since i think i ll be okay with taking tih swiss time but a bit confuse worry i will prolong time for efavirenz once i touch down on zurich.

Any ideas. Thx so much for ur support."

Here was my reply:

"Hi there,

My deepest apologies for my late response. I have not checked this email for a long time, and I'm surprised that I have quite a few enquiries!

My response may not be relevant to you anymore, but I will share my opinion nonetheless. 

One of my doctors told me that if I were to travel to a place of a completely different time zone, I should follow the local time in my destination. This is for adherence. I've been told that the reason they instruct their patients to take their meds at 8am and 8pm is because these times coincide with activities we do in our normal daily routine (e.g., going to office, having dinner, etc.) which makes it easier for us to remember that it is time to take our meds. 

I also take my meds twice daily, at 8am and 8pm, same as you do. Right now, I'm in Europe, and if I were to follow the local time, then I would have to take my meds at 2am and 2pm, which was difficult to adhere to. So what I did was I took it the same time, as per normal in the Philippines, on the plane, and until the day I arrived at my destination. Then I adjusted taking my meds to 8am local time the following day after I woke up.

So when I travel, if the time difference is not too much, say an hour or two, that will not interfere with my routine, then I take it the same time I do at home. But if there is a huge difference, then I use local time in my destination.

Again, these are my opinion based on my personal experience and my doctor's advice. Please seek your doctor's advice because we have our own peculiarities."

Cheers!

HIVPlus4Plus

New Twitter Handle.

Hello dear readers and followers of my blog! Did you miss me? I know it's been a while since the last time I updated my blog, and I would like everyone to know that I'm all good and well. Buhay pa po ako. Hehe.

I've been quite busy this year, with work mostly. So what's happened to me since my last update? Hmmm, let's see...

First, my primary doctor, Dr. Mark Pasayan, is finishing his fellowship at RITM soon and he said he won't be putting up clinic in Metro Manila. So with heavy heart (*sob*), I transferred to Dr. Manolito Chua. Dr. Chua is one of the most senior consultants at RITM so I know I'm in good hands.

Second, my cocktail was changed back to the original Nevirapine-Lamivudine-Zidovudine combo. Yes, zidovudine. The one the we suspect caused my anemia. How did this happen? Well there was a big issue about ARV supplies early this year, and there was a shortage of Tenofivir. It was so bad that medicine refills were done weekly in RITM, and even daily in Makati Med! Since I'm out of the country most of the time (yes, my work requires me to travel a lot), getting my meds on a weekly basis was not an option. So Dr. Chua put me back on trial with zidovudine, which started on May 10, 2014. And guess what? My hemoglobin was steady, even up to this day after 6 months. So perhaps it wasn't really zidovudine that caused my anemia, huh?

Third, my CD4 count last June 1, 2014 went down again from 329 to 260. Big drop. So I had my viral load taken. The result took almost three months to be released, but thankfully my viral load was still at undetectable levels. Baka stress lang sa work kaya bumaba. Or maybe it's an effect of changing meds? Definitely I look forward to seeing my count move up next January, because if it drops some more, I'd be worried.

Lastly, I changed my twitter name, in case you want to follow me. It's now @ako_si_mister_B. So add me up!