more twice a day for treatment experienced, page-7

W, you may be right. The studies I've seen have all been pretty firm on advocating daily over twice (or more) daily, but there are some counter arguments to that, including a few that I have only just been told about. This is an excerpt from an email sent to me by someone who is an expert in this area (sorry, I don't divulge contacts). it was in response to an email from me asking about this issue. I still think that daily is preferable (otherwise the daily would all switch to half dosage twice daily!), but it probably isn't a deal breaker...

The once-a-day phenomenon, has to do with convenience. This convenience is particularly useful if you are a newly infected person and have still a very healthy body and busy lifestyle. Contrary to the studies you may have seen, there are others, and a widely held belief in many older more experienced GPs, that suggest that once-a-day non-compliance gives a worse outcome that twice a day non-compliance. In other words a patient is less likely to forget to take both his doses in a day, than forget one. Now you are absolutely correct that the evidence for ATC shows it to be a most forgiving drug, i.e. the odd lost dose here and there doesn't adversely effect the efficacy too much. This is not true for all HIV drugs. There is another issue that I have not seen discussed, and that is when many of the front line medicines become generic, do you think the health insurance companies with continue to reimburse the high costing once a day drug combinations, I think possibly not, and they will advise patients to take the individual cheaper products. Finally while a lot is spoken of once-a-day and convenience, the actual long term experienced HIV infected individuals that I speak to regularly all tell me how many tablets they have to take, and while it is inconvenient, by the time you get to where they are in the infection, they make every effort to take as many as often as is required.

Hope that helps.