Hello Doc,

I've been on Atripla for 10 months,with 99% adherence. Started having Neuropathy since July this year CD4 was 55 on January this year and co infected with TB. TB meds stopped by the doctor on July.

Here is my records; -Jan :CD4 55, VL 500.000 -March : CD4 150,VL 400 -May : CD4 437 ( 18%), VL 90 -July : CD4 380 ( 18%), VL Undetectable (<40) -September ;CD4 400 ( 20%), VL Undetectable (<40) -November:CD4 280 ( 20%),VL 49 and Mild ALT elevation ( 42) My Doctor said about my viral load; 'It's Only a Blip' And He also said nothing to worry about my previous CD4 Count ( 280/20%) because the percentage remain the same with the result in September. My next appointment will be on February next year. Are you agree with him that "It's only a Blip'? and how about my CD4 count that dropped quiet significant from 400 to 280? I'm worried the HIV started to resistant with Atripla... And Also do you think wouldn't be too long for my next appointment in 3 months later due to my condition now? Please Advise,

Thank you so much,Doc...

Hello and thanks for posting.

A single viral load of 49 is usually of no great concern (other than causing apprehension and a chat with our online forum). I'd ask you if you had a missed a few doses of medications or (more likely) a cold or herpes outbreak or the like around the time of the lab tests- these usually account for the low level detectable VLs.

While a blip is formally defined by having a return to undetectable, we have ample evidence that such tests are typically not significant and the next tests return to undetectable levels.

If you were my patient, a three month follow up would be fine, but if questions persist, a VL test sooner wouldn't be unwarranted.

Hope that helps; and have a great holiday season. BY