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HIV Drug ResistanceHIV Drug Resistance
           
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I cant believe I forgot my Atripla
May 29, 2007

I have been taking Atripla since early April of this year as a first line of meds/treatment (meaning just diagnosed and placed on meds). The results have been astonishing. My T cells shot up over 218 from the original, very low number, however two nights ago, I completely forgot to take my medicine. I usually take it no earlier thatn 9:30 but no later than 11:00 PM depending on my last meal. This particular night I cant believe I forgot and went to bed. I woke at 8:00 AM, relized my mistake and took it right away then later that night resumed my regularly scheduled meds. Did I open a window for resistance? This is such a great fear for me. Furthermore, even if I take my meds everyday, ontime for as long as necessary, does the virus still develop resistance and if so, how long does that take?

Response from Dr. Sherer

Yes, you did open the window for resistance by taking your medication after a longer interval than prescribed, but to a very small degree. You did the right thing to take your meds as soon as your realized the oversight the next morning (rather than waiting until the next dosing time later that evening).

It sounds like you have had a good response since April, but you did not report whether your viral load is below the level of detection or not. My level of concern for the impact of this missed dose would be a little greater if you had yet to achieve a viral load below the level of detection in the blood. In the presence of complete viral suppression in the blood, i.e. with a viral load below 50 copies/ml, it takes some time for viral replication to resume after stopping ART, around 4-6 days.

In any event, you and your doctor can assess whether any resistance has occured by closeling monitoring your viral load and CD4 cell count in the next months, and by doing a resistance test if your viral load is above 1,000 copies/ml.

Unfortunately, your regimen is vulnerable to even brief periods without adequate drug levels in the blood, so I would urge you to take every possible measure to not miss doses in future.

And I suggest that you your question and this response with you to your next doctor's visit and talk to him or her about it.


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