Factsheet Travelling with HIV medications – time zone changes

If you are taking a long flight and travelling across time zones, this will have implications for the time you take your medication.

Taking all the doses of your medication, at the right times, is the most important thing you can do to ensure that your HIV treatment works. Nonetheless, if you are doing well on HIV treatment and have an undetectable viral load, then a single dose taken a few hours earlier or later than usual will not usually cause problems.

This factsheet summarises recommendations on how to manage the time of your doses when taking long flights which involve changes of time zones. The group of doctors who created the recommendations tried to keep their advice as simple and practical as possible. (Nonetheless, if you already have another system which works well for you, then you can probably stick with it.)

"If you usually take medication with breakfast at home, you should take it with breakfast during your trip."

When it is safe to do so, they advise against taking medication during a flight as the confusion about time zones can make it easy to miss doses.

If your drugs should be taken with food (or on an empty stomach), then you also need to follow this advice while travelling. Not having control over meal times on planes can make adherence more difficult during a flight.

After arrival, it’s best to get into the new time zone as quickly as possible – if you usually take medication with breakfast at home, you should take it with breakfast during your trip. Keeping the same routines around pill taking will probably help your adherence.

These recommendations only apply if you are stable on treatment with an undetectable viral load.

You’ll need more specific advice and planning from your doctor or a pharmacist in any of the following situations:

• A viral load which is not fully suppressed.
• You have HIV which is resistant to some of the drugs you are taking.
• A complex itinerary with multiple changes of time zones within a few days.
• A journey lasting more than 24 hours, for example to or from Australia.

The following advice applies to modern anti-HIV drugs which are taken once a day.

However, slightly different advice is given later in this factsheet for efavirenz (Sustiva) and Atripla, a combined tablet which contains efavirenz. Also, these recommendations do not apply if you are taking Kaletra once a day (see Special cases).

• On the day of departure, delay your dose until a few hours before the flight.
• Take another dose when you arrive.
• Take the following dose at your usual time, but in the local time of your destination.

For example, if you usually take your pills in the morning and you are taking an evening flight that will last eight hours or more, don’t take your pills in the morning. Take them instead during the afternoon or early evening. Take another dose just before or after the plane lands. The next time it is morning in the country you are in, take your dose as usual.

The following advice applies if you are taking efavirenz (Sustiva) or the combined tablet Atripla (efavirenz, emtricitabine, tenofovir disoproxil). If you sometimes suffer from the side-effects of anxiety, dizziness, mood changes and vivid dreams which these drugs can cause, you may want to avoid having these feelings while you are in the airport and getting on the plane. These side-effects tend to be strongest around four hours after taking the drug.

• On the day of departure, avoid taking a dose a few hours before check-in and departure. Otherwise, take your dose at your usual time.
• Take another dose when you arrive.
• Take the following dose at your usual time, but in the local time of your destination.

For example, if you normally take your pills in the evening and are taking a daytime flight, take your usual dose the night before departure. Take another dose just before or after the plane lands. The next time it is evening in the country you are in, take your dose as usual.

But if you usually take your pills in the evening and have an evening flight, you could decide to skip the dose you would usually have around the time of departure. The drug you took the previous night will still be in your system and will continue to control HIV. Take another dose on arrival and another one the next time it is evening in your destination.

This advice applies to modern anti-HIV drugs which are taken twice a day. On a long flight, a dose while on the plane will be necessary.

• On the day of departure, delay your dose until a few hours before the flight.
• If the flight is longer than twelve hours, take another dose at a convenient time during the flight.
• Take another dose when you arrive.
• Take the following dose at your usual time, but in the local time of your destination.

If you are taking Kaletra (lopinavir, ritonavir) once a day, then it’s important to avoid delaying or missing doses. You should take your pre-departure dose at your normal time, take an extra dose during the flight and then take the following dose at your usual time, but in the local time of your destination.

Generally, atazanavir (Reyataz) is taken boosted with ritonavir or cobicistat, along with two other anti-HIV medications, once daily. However, if you are either taking it without ritonavir or cobicistat, or without other anti-HIV medications (as monotherapy), then you also need to be careful to avoid late doses. Follow the same advice as for once-daily Kaletra in the previous paragraph.

If you are taking darunavir (Prezista) boosted with ritonavir or cobicistat, without any other anti-HIV drugs (as monotherapy), you should follow the same advice as for twice-daily drugs. You may need to take an extra dose during the flight.