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Nov 4, 2007

Hello,

I have two unrelated questions:

1) I take Atripla. I will be traveling in December and moving time zones (7 hours forward). I take the dose in the evening. How do I adjust my pill dosage? I figure going I could take the pill at the same time since it would be the same as taking it 7 hours early. But I don't know how to adjust it coming back b/c then taking at the same time I took it while traveling would be like taking it 7 hours late.

2) I just read an article about that vaccine trial that failed recently and it said one of the challenges to vaccine development is that scientists don't know what an effective antibody response that prevents HIV looks like. Why can't they just do a computer simulation? Why couldn't they just plug into a computer everything known about HIV and everything known about the immune system and then tell the computer to figure out an effective immune response?

Response from Dr. Wohl

Question 1: I think you can take the medication early on arriving at the next time zone. That is if you take it at 10pm your time, take it around 10p when you get there. On returning to your time zone take the Atreipla earlier than usual such as around 6 or 7pm and then the next day go back to 10pm.

Question 2: There are two major arms of the immune system, the humeral and the cellular. The humeral response depends on antibodies to attach on to the invading organism. The cellular response looks to cell to recognize and attack the organism. These two systems work together such that a germ coated with antibody looks super yummy to a germ eating cell. Most of our effective vaccines fake out the body to make lots of antibodies to the thing being vaccinated against.

In the case of HIV, antibodies alone don't work and we know that antibodies alone don't protect against infection or re-infection. You need a good cellular response too. Here in lies the rub - provoking a cellular response is not so easy. So, an effective HIV vaccine needs to be able to get the body to mount a vigorous immune response that is even better than the response the body would make to natural infection. Improving on Mother Nature is not easy.

DW



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