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Vaccination and atripla
Oct 14, 2012

Hi Dr. Young,

It is said pretty much everywhere that recent vaccinations can cause viral load spikes. I have hard time understanding how this is possible if a person is under effective treatment. Isn't the combination therapy supposed to suppress viral replication? The second question that I have is that do such VL spikes caused by vaccinations actually put a person under treatment in risk for developing resistance? If there is viral replication going on in the presence of drugs, my understanding is that this is pretty bad.. The reason I am asking these questions is that I received a yellow fever vaccination yesterday. I am on Atripla, my last test was 3 months ago (VL<50, CD4: 520, 29%). My doctor said that I would not have any problems receiving this vaccination, but I'd love to get your opinion as well. Finally, I am due for my next bloodwork in 10 days. Do you think I should wait a while, in case my VL has skyrocketed due to this vaccination?

Response from Dr. Young

Hello and thanks for posting.

It's generally thought that the blip in viral loads that occurs after vaccination is due to the activation of the immune system (including those pesky infected cells), rather than issues related to viral drug resistance. There's no evidence that vaccines increase one's risk of developing drug resistance.

Yellow fever virus vaccination is generally safe in people who have undetectable viral loads and with CD4s higher than 350 (like you).

After getting vaccination, I generally try to wait a couple of weeks before getting HIV viral load or CD4 count testing. (Usually though, we're not talking about "skyrocketing" values, but rather, if detectable at all, only in the low 100s).

I hope that helps, BY

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