Hello Dr. Young,

My recent labs on Atripla are very good...undetectable and tcells up to 500/31% from a low of 250/18% six months ago. I have absolutely no side effects. My problem is that I have noticed that I have been missing between one to three doses a month for various reasons. Is this enough to cause concern for resistance? I'm learning to be more prepared (when traveling or running low on meds etc.)and disciplined, but are these missed doses to date a problem? Thanks again for all of your help. JB.

HI JB, thanks for your post.

It sounds like you've had an excellent initial response to your medications-- this, more than anything means that your missed doses probably are not of any practical significance.

We talk a lot here about achieving a 95% adherence level for optimal response rates-- this calculates to about 1-2 missed doses per month. There are some more recent data that suggest that a somewhat lower level ~85% might be "good enough" with newer drug regimens, liek the Atripla you're taking. Either way, missed doses are something that should be avoided; I'm encouraged to hear that you've taken steps to avoid missing.

All the best, BY