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Atripla with food and Viral Load
May 4, 2014

I was infected on Nov 26 2013 and started treatment on Jan 02 (VL = 1400, CD4 =535). Three weeks later I came back to the US and started on Atripla (VL = 750, CD4 =550) with the expectation that my VL would be undetected in 8 weeks. I tested on April 21 (VL = 140, CD4 =750) and was disappointed that VL was still there. My doctor thinks it is because I am waiting 1:30 after eating as opposed to 2:00 as required. I asked Walgreens and the pharmacist said if I don't wait enough absorption is lower. Every place I read says the opposite, and that besides side effects (have none), I shouldn't worry about food. Is it normal to have such a long time to reduce VL to UD? Were my doctor and pharmacist both misinformed?

Response from Dr. Holodniy

The official package insert for Atripla indicates it should be taken "on an empty stomach". In addition to reducing side effects (which you don't apparently have), that is why we recommend taking it at bedtime, as that would be long enough after a dinner meal for most people. Certainly longer than 2 hours. Two other points to consider, was a HIV resistance test performed prior to starting Atripla? It is possible that resistance to one of the components might be present. However, the viral load is too low to get that test done now. In addition, are there any other medications you might be taking that could be interacting with Atripla, and hence the antiviral activity of the meds?

Viral Load Undetectable, but Decreasing CD4
High viral load and reasonable CD4 count for 2 years

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