Initiating HIV/AIDS Therapy in Treatment-Naïve Patients How important is dosing symmetry?
	Enlarged Version of Graphics Below	Dr. Wohlfeiler (OC): If you can achieve it, I think that it's great and preferable to have things that are on the same dosing schedule, everything once a day, everything twice a day. I think though if you feel that the best antiretrovirals for that patient or the best regimen includes once a day and twice a day medications, I don't think that just because you don't have that symmetry, that should stop you from prescribing those meds. I try to achieve symmetry. I try to keep everything the same. But if I really think that somebody needs medications that don't fit into that, I don't hesitate to prescribe those. Dr. Kwakwa (OC): I think the potential drawback of dosing symmetry is the related concept-the related, really, marketing concept of pharmacokinetic symmetry, which really doesn't exist in HIV medicine, and so if you're talking about pure dosing symmetry, and not pharmacokinetic symmetry, I think there is a reason for dosing symmetry; for patients who may be forgetful, for patients who may find it more convenient to take all of their medications each time they take a dose of medications, I think that is an important attribute to add to a particular medication or regimen. I would say that for the majority of my patients, that is not a concern. Dr. Bellos (OC): I think it is very important for a patient that is initially starting therapy, because you want to be able to simplify the regimen as much as you can, so if you can drastically reduce pill burden, and have someone, say, taking two pills at night before they retire, that would actually be a significant improvement for that patient who is initiating therapy, because one of the things I think we have to remember, especially with our naïve patients, is that they've just been given a diagnosis. A lot of them currently really don't understand the significance of that diagnosis and what it means, and then, you're going to now burden someone with having to take pills daily that may have side effects, and so you've got a fair number of psychosocial factors that go into making the decision about initiating therapy, and that is one of the things that I always take into account when I initiate with whatever regimen: Is the patient ready to start therapy? Because even if I am, and the patient is not, it's not going to make any difference. The patient is not going to be successful if they are not ready to embrace therapy, and truly understand the meaning of beginning HIV therapy.
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