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Can't become undetectable on Atripla

Mar 10, 2013

Hi Dr. Young, I am a 35 yo male, who started using Atripla in 2008 (CD4 nadir : 320). My numbers improved quickly, and VL became undetectable within 6 months. However my last 5 tests within the the last 2 years indicated stable, yet detectable VL. Nov 2011: VL: 55, CD4: 517 / 26% March 2012: VL: 55, CD4: 560 / 35% June 2012: VL: 24, CD4: 555 / 29% Oct 2012: VL: 50, CD4: 630 / 37% Feb 2012: VL: 24, CD4: 760 / 30%

I live in France and here they use Roche TaqMan kits for VL assays. The cut off for being undetectable is <20. Otherwise, I feel very healthy and I don't miss my doses. My doctor is not worried and she does not suggest switching to another combination. I would love to get your opinion as well as this is somewhat unsettling for me.

Response from Dr. Young

Hello and thanks for posting from France.

I share your doctor's opinion- viral loads in this range are usually not of any concern, and I don't see anything that would indicate a need to switch medications. It's understandable why you'd be unsettled, given all the focus on being undetectable, though.

Minimally, it's worth asking if you had any colds or infections when your testing was done- things as minor as a cold sore (herpes outbreak) could easily cause such low level tests.

Hope that helps, BY

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Changing from Epzicom+Prezista+Norvir to Combivir+Sustiva

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