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concern about efficacy of atripla

Oct 20, 2012

Dear Dr. Young,

Thank you for your encouraging reply to my first mail to you. I am a sixty three year old man who tested positive in May for HIV. My initial VL was 497,000,CD4 was 173 and % was 16. After one month on Atripla my VL was 3050,CD4 was 234 and % was 23. After the second month, my VL was 1590, CD4 was 258 and % was 22. Another month has passed but the doctor does not want to see me again until December. I am concerned about whether Atripla is continuing to work well for me, and am anxious to get my VL to an undetectable level, so would you advise having the VL and CD4 levels checked again now? Thank you very much.

Response from Dr. Young

Hello- it's good to hear back from you.

It's understandable that you'd like to see your viral load at undetectable levels- this is the goal of treatment and can also reduce your risk of transmitting HIV.

Having said that, recognizing that your baseline viral load was very, very high, it will take longer to reach that magical undetectable threshold. Actually, looking at your numbers, you've had a 1600/490,000- or 99.7% reduction in viral load in the first two months of treatment. This is indicative that your medications are very active against your viral strain. So, in sum, I think that you're right on track with the viral load performance.

One thing to note is that it's important (especially with your age) to monitor for toxicity of medications, especially for the possibility of kidney toxicity from the tenofovir part of your Atripla. Your kidney function should be assessed by blood and urine tests at baseline and by blood tests every 4 months thereafter. We use the MDRD equation calculator to estimate kidney function. Note that if your value is less than 50, you can't take Atripla, as the dosing of the medication components differ in this setting. For example, if you use this calculator (and if you're Caucasian, this means that for a serum creatinine test result is higher than a not-so alarming 1.4 mg/dl, your estimated kidney GFR is about 50.

I hope that helps. Thanks for posting and stay in touch. BY

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