Dear Dr. Sherer, How can I tell the difference between symptoms when experiencing an illness which might drag on for a few weeks (like a nagging cold, flu, or bronchitis which is often accompanied by body aches and high fever) or if I am developing resistance to my HIV medication (Atripla). Three months ago, I was undectable and my CD4 count was approximately 280. I am concerned, as I must wait until I am feeling well to have blood drawn, as an illness can throw off my test results. Thank you for your feedback!

Most often, the emergence of drug resistance is not accompanied by any signs or symptoms. Rarely, the development of resistance could be accompanied by a sharp increase in the viral load and the return of acute HIV-related signs and symptoms such as fatigue or rash.

Far more likely in your situation is the occurrence of a viral upper respiratory infection, i.e. a nagging cold or flu, with or without bronchitis or fever. People with HIV will suffer the same seasonal infections that are common in the general population, so its important not to overreact to episodic temporary illnesses. I would suggest that you talk to your doctor when these illnesses occur, in order to be sure that you are not experiencing an HIV-related opportunistic infection.

You are correct that a short term viral illness might cause a transient rise in your viral load, but you and your doctor will be able to identify situations in which that has occurred, and it usually will not result in any long term harm to your response to ART.