hello. cd4 is currently 595, and undetectable for 3 years. i am recenlty this month have missed a couple of doses of atripla and ziagen in two seperate days. i usually take my meds at night, knowing that i missed a dose the next day i cant really take onother dose during the day time because i go to school. would it be okay to take it at night before i go to bed even though i missed a dose a day before? missing a dose from time to time can cause a dramatic drug resistance? my doctor says it usually takes about 2 to 7 days of missed dose before it can cause a problem. will i be okay?

Thanks for your question.

It is true that missed doses can be a problem for maintaining suppression of HIV on treatment. The pattern of misses is important. Someone with a fully suppressed virus, such as you, is in a better situation them someone just starting treatment when the virus may still be actively growing. Once the virus is suppressed, your doctor is right, it may take several days for it to "wake up" and grow to the point of being detectable. So an occasional missed dose will not cause any problem. If, however, there is a pattern of irregularly taking meds over a long period of time, then that may allow the virus to re-emerge or never get fully suppressed, that is a more dangerous situation because you have virus growing in the presence of low doses of the meds, that is the optimal time for viral resistance to emerge.

So, your rare missed dose should be OK as long as you keep on top of it. Taking an extra dose the next night would not be needed.

Good luck in school.

Joe