|Regularity of taking meds and PI resistance
Sep 20, 2004
Hello. After four years on sustiva, epivir and viread, I have just replaced sustiva with atazanavir in order to avoid sustiva's side effects. I recently read about a Spanish study which found that HIV replicates more quickly than previously thought, and that even a short amount of time with low levels of PIs could result in viral escape. I have a constantly changing work schedule and have never been too concerned about taking my meds at exactly the same time every day. Although I may take meds as much as four hours later on some days, my viral load has remained undetectable. However, I'm wondering if I need to be more regular with atazanavir than I was with sustiva. For the record, my CD4 count is in the 500-600 range, and my CD4% is around 48.
Thank you for your fine work on this site.
Response from Dr. Sherer
The pharmacokinetics of atazanavir suggest that a delay of 4 hours should not lead to a high risk of resistance, but would expose you to a low risk. Hence the above precaution is still the best option.
Some clinicians might also recommend that you use the boosted form of atazanavir in order to avoid resistance; this is particularly true at the end of the twenty four hours, if delays past 24 hours are common. In that case, the dose is 300 mg ATV + 100 mg RTV daily.
I urge you to talk to your physician about this question and formulate a strategy with him or her.
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