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Feb 2, 2014

Dear Doctor Young,

Last month I had to miss 3 days in a row of Atripla through circumstances beyond my control. My last lab result showed an increase in VL from undetectable to 180. I had previously been on Atripla for 18 months and been UD for 14 months. My last CD4 count showed an increase from 290 to 370. I am worried that this result may be the start of resistance due to my missed doses and I'm realy panicing here. Would you suggest immediate retesting?

I would also like to ask if switching treatment earlier would decrease the risk of resistance to all components in Atripla, or if the worst has happened would it be too late, as resistance has already taken hold?


Response from Dr. Young

Hello and thanks for posting.

Usually, if you've been undetectable, there's very little risk of developing drug resistance with a single interruption of all your medications (as would happen if you stop Atripla).

So, no panic needed. What I'd suggest is contact your care provider and simply have a viral load test performed about 4-6 weeks after the missed dose. If undetectable (as I'd wager), then there's nothing to worry about.

If the worst case, if the virus has returned despite good adherence, there are a wide range of excellent second line options.

Be well, BY

Anti HAV IgM nonreactive, IgG reactive but showing present symptoms of Hep A
Afraid to Take all meds at once

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