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starting atripla with high viral load

May 24, 2013

dear doctor,

I was possibly infected with hiv in january 2013 and had acute infection with high fever,enlarged neck lymph node,and muscle pain. on 28 march 2013 I was diagnosed hiv+ in a university hospital in istanbul. my initial test dated 28 march was :cd4count 336, cd4% 16, vl 748 000 and I started waiting for the resistance test. meanwhile I took another cd4 test 2 weeks later( april 16) in a trusted private lab: cd4 333,cd4%10.4 and I went on waiting the resistance test result but it did not come out because of a problem with the instrument "kit". and on may 18 I took another cd4 test in private lab: cd4 count 267,cd4 %10.3

I had panic a bit because of the drop in cd4 and went to univesity hospital immediately. they told my resistance test will be ready 3 more days later ( on 22 may) but the doctor,seeing me in panic, started me with atripla ( truvada and stokrin)...I had drugs today but not used yet. I think my doctors immediately should have started me with meds on my diagnosis because of high viral load and low my question 1 is: should I wait 3 days more for the resistance test result? and 2: is it sensible starting with atripla with high level rna copies( 748 k)?

thanks in advance for your help.

Response from Dr. Holodniy

It is conceivable that your viral load has come down somewhat from 748K, it that was indeed acute infection in March. If the results are still not back, you should start now, and Atripla is not unreasonable. If adjustments need to be made, either because of underlying resistance or you are not getting your viral load to undetectable in a reasonable time frame, you can modify your regimen then.

Is Mararviroc safe question.
First time drop in CD4 after taking Atripla

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