Professor Khoo admitted that he was “somewhat surprised,” when he first learned just how common that worry, really is. When he asked patients and advocates about it, “there appeared to be considerable and widespread concern from the community” about medication dosing during international travel. Like many of his colleagues, Dr. Khoo admits that he had simply not thought a great deal about it–and had even assumed that new treatment regimens had rendered this issue a “non-problem.”

Professor Khoo and Alain Volny-Anne, of the European AIDS Treatment Group in Brussels, Belgium, hosted a symposium at the 2012 international HIV Glasgow meeting, specifically to discuss antiretroviral dosing during international travel. “There was considerable discussion and interest both during and afterwards,” Dr. Khoo recalled.

“Patients do have a life, and it is important to shape long-term treatments around this,” Dr. Khoo said. “And what patients and their doctors regard as important may not be the same thing. International travel with medications is a very neglected area in both regards—especially medications with food restrictions, particular storage requirements, injections, neurological or gastrointestinal side effects.”

Feedback from the symposium eventually led to Dr Khoo and Volny-Anne teaming up with other colleagues to write a newly-published review in the journal AIDS.1

The paper presents “currently available data on the pharmacokinetic forgiveness and toxicity of various antiretroviral regimens, and synthesize this data to provide guidelines on how to safely dose antiretrovirals when travelling across time zones,” the authors note in the paper.1

The biggest dosing issue for long-distance travel is “suboptimal dose spacing” that can result from “opportunistic pill intake,” and changes in dosing associated with a new time zone and altered sleep pattern, the authors reported.1 It is all too easy for a tired traveler to sleep through the next due dose, for example.

Generally, “due to confusion regarding times and fixed [in-flight] mealtimes, we recommend avoidance of in-flight dosing if possible and safe,” they noted.1