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HIV Drug ResistanceHIV Drug Resistance
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Jul 10, 2007

DOC,I am currently in quite the pickle,I was diagnosed with HIV/AIDS on Oct 05th 2006,I have had & maintained an undetectable viral load for a few months now,but am currently having issues with my insurance. Being that its the weekend, I am not going to be able to solve this problem until Monday which means that I am going to miss my Sunday night dose of Atripla,I am very upset and afraid of what this may cause to happen,please let me know your expert advice on the subject.Thank You eve so much

Response from Dr. Sherer

I advise my patients to try to keep a small stockpile of their medications to cover these kinds of circumstances.

As you suggest, it would be best not to miss or be late on even a single dose with Atripla or any regimen containing an NNRTI like efavirenz or nevirapine, because they are prone to rapid development of resistance. One option would be to simply purchase a single Atripla pill while you straighten out the insurance issue on Monday, just to give you a little more time, but I appreciate that even that may be beyond your financial means.

The good news is that a single missed or late dose alone is unlikely to cause treatment failure (although that allows for the remote chance that it could). Several studies looking at single missed doses with efavirenz did not show a higher rate of regimen failure. There are also reasons to think that the excellent performance of the Atripla combination specifically is due to the long half lives of the other medications in the regimen, i.e. the tenofovir and the emtricabine (FTC).

Finally, my advice is to get in touch with your doctor ASAP when you realize that such an event might occur, as your doctor and his or her staff may have other sources of temporary drug support for this type of occassion, and they share your urgent desire not to have any lapses in your medication adherence.

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