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yellow fever vaccination under Atripla and possible VL spike

Oct 7, 2012

Hi Dr. Holodniy,

I've been on Atripla for the past several years. My last bloodwork was 3 months ago, VL<50, CD4 525, 29%. Couple days ago I had a yellow fever vaccine. I am due for my next bloodwork in a week. Should I postpone it? I hear that recent vaccinations can skyrocket viral load, but is that true for people on treatment as well? How can the viral load go up if the person is under effective therapy? And if there is substantial viral replication going on in response to vaccination, doesn't that put the person at risk for developing resistance, given that the virus is now exposed to molecules in Atripla?

In any case, how long do you suggest I wait before I do my bloodwork?

Response from Dr. Holodniy

Yes, the vaccine could affect viral load, and would be more likely to do that in people who are not on HIV treatment, or in those on treatment with a detectable level of virus. The risk of a vaccine causing an increase in viral load, leading to resistance while taking HIV meds, is theoretical and to my knowledge has not been shown. I would wait about 4 weeks after getting a vaccination prior to getting your routine labs done.

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