Hello Dr. McGowan I do hope that this message reaches you well. I am a 23 year old university student who has been positive since 15 Dec 2007 . This summer from 30 May 2009 - 15 August 2009 I will be finishing up research on human rights practices in Ghana for a fellowship that I have and thus will be in Ghana during the said dates. I am currently undetectable with a CD4 count of 700. My regimen is Atripla . I usually take my medication 5am ET and just wondering how would I administer my meds given that I will be in Ghana where the time is four hours ahead of New York standard time. I have spoken to my doctor about this and she told me that I should take it New York time but at the time which corresponds to Accra, Ghana time. So 9 am Ghana time which will be 5am New York time. As a second opinion what would you suggest ? I will be getting a 90 day supply of my meds and thus will travel will keep them in the bottle but in a medical kit packed with band aide, peroxide, antihistamines, and any other this that I might need when abroad. Do you have any suggestion on what to bring aside from what I have mentioned? I am getting my shots and seeing my doctor before I depart. However since I will be required to take malaria pills (once a week regimen) while I am there and up to four weeks after I return, how will this counter, if at all, or coincide with my Atripla? Please let me know what you think. Thank you in advance for your advice and or recommendations.

Thank you for your work on human rights, I hope you ave a successful trip.

Since you will be 2 1/2 months in Ghana you should adjust your schedule to your new environment. Shift the meds to the new time zone when you arrive (which will be 4 hours early the first day). Then you will stay on a 24 hour dosing while you are there, then shift back to NY time on your retrun (4 hours late that one day). That will not effect your viral control.

You should be sure to bring mosquito repellant (containing DEET- higher concentrations, up to 50%, are better), use pyrethroid-containing flying-insect spray and insect treated bed netting if you are not staying in an air conditioned room.

It sounds like you will be using mefloquine (once weekly) for malaria prophylaxis, there are no known interactions with Atripla.

Good luck and stay healthy.

Joe