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Drug interaction with acyclovir?
Jun 4, 2006

I have been on sustiva and truvada for almost a year. VL was undetectable and CD4 was over 800. Then I had a herpes outbreak, so I took a 5 day course of acycovir (200mg, 5x a day) as prescribed. Shortly after, my VL was up to 3,300. Thankfully, about 6 weeks later, it was back to undetectable. Could the herpes have a part in the blip up? Is acyclovir counterindicated when taking sustiva or truvada? The reason I ask is that the pharmacy insert that came with the Truvada said to make sure your physician or pharmacist is aware if you are on any other antiviral medication, and specifically mentioned acyclovir. Thanks, as always, for your advice.

Response from Dr. Pierone

We always try to explain an anomalous viral load spike by blaming it on an intercurrent viral infection. In your case the herpes outbreak may well have been the inciting event. Herpes simplex virus can act as a trigger for activation of HIV-infected cells and subsequent increase in viral load. There is no problem using acyclovir along with Sustiva and Truvada. The expectation is that with HSV suppressed you should have an undetectable level of HIV RNA next time. If things don't return to undetectable then you would need to have a viral resistance test. Best of luck!

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