Missing PreP doses, HepC meds

With the new medicines for HIV, is it really necessary to take all of them or is it okay to miss doses?

The easy and quick answer is: “Do not miss doses of your medications! Take them every day, just as they are prescribed.” As one patient said when I had answered this question (for what seemed like hundredth time, both to him and to me), “Come up with a new line, doc.” I guess the answer does come across like a reflex that I haven’t rethought since 1987.

The medication AZT was licensed by the FDA in 1987. Patients were instructed to take the pill every four hours, around the clock. I know, crazy.

Those were the “Dark Ages” compared to 2018. HIV infection had become the most common cause of death for people aged 25–45 in the US. After 1996–1997, however, the number of deaths due to HIV dropped by almost half and have continued to drift downward. But that number has not reached zero.

So why am I still advising “Don’t miss doses!” in my sleep? The new medicines, now often one pill a day, are very good at stopping HIV from making more HIV. But HIV can overcome even these most powerful of medicines, especially if given the chance, such as missed doses of medicines. So, do yourself a favor and DO NOT miss doses.

In the meantime, I’ll try to come up with a new line that doesn’t sound so 1987.


Dennis Melton, MD
Board Certified in Infectious Diseases & Internal Medicine
AbsoluteCARE Medical Center & Pharmacy


My doctor has always told me not to worry about my Hepatitis C infection, but I hear there are new drugs available. What may have caused my Hep C and what should I do?


Hepatitis C is a viral illness that causes liver inflammation. Approximately 3.5 million people in the U.S. are infected with it, and half the people infected don’t know that they have it. Hep C usually causes very few symptoms.


Baby Boomers have the highest risk for contracting chronic Hep C. Risk factors for the illness include current or former injection drug users, snorting cocaine, recipients of blood transfusions or blood products before 1992, chronic hemodialysis patients, receiving tattoos from unsterile needles, children born to Hep C-positive mothers, sex with a Hep C-infected person (especially men who have sex with men), and sharing personal items that have infected blood. (Think shaving razors or toothbrushes.)


After becoming infected with Hep C, 70–85 percent of sufferers develop a long-term chronic infection if left untreated. Only 15–25 percent of Hep C infections clear spontaneously without treatment. Untreated Hep C infection can lead to liver cirrhosis, liver cancer, and death. Hep C-related deaths in the US have exceeded the number of deaths associated with HIV and 59 other infectious diseases combined since 2013.


There is no vaccine against Hepatitis C. However, new oral Hepatitis C medications have a cure rate of 95 percent after 2–3 months of therapy. Therefore, anyone with chronic Hepatitis C infection should be treated.


Michael Brown, MD
Board Certified in Infectious Diseases & Internal Medicine
Certified by the AAHIVM
AbsoluteCARE Medical Center & Pharmacy