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HIV Drug ResistanceHIV Drug Resistance
          
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HIV & ALTRIPLA
Aug 27, 2007

I just found out I was HIV positive about a month and a half ago. I did the blood work and my labs came back with a CD4 count of 356 and Viral load of 70000. I read somewhere on this site that with these numbers I don't need to start treatment. However, I went to the doctor this past week and he recommended that I do start treatment, Altripla. I have take two doses of it. I was wondering, should I continue this medication since I already have taking two doses? Or if I stop will I build a resistance to it, and once I get on medication again, can I be given the same medication or will I have to take different medications. Please Help!

Response from Dr. Sherer

Your CD4 cell count and viral load are such that you could reasonably decide to start ART, as you and your doctor did decide to do, or your could wait for a brief period to see the trends in your CD4 cell count and viral load and decide at that time, e.g. in 2-3 months. The current thresholds for recommending ART in an asymptomatic person are a CD4 cell count below 350 and/or a viral load above 100,000 - so you are very close with both lab tests.

Now that you have started ART, I strongly suggest that you continue to take it every day as prescribed until you see your doctor again. Yes, you could develop resistance if you suddenly stop your ART after two doses; in fact, you are most vulnerable to drug resistance now when you have a higher viral load than you are likely to have after only a month or two of ART. For this reason, take all doses as prescribed, and then see your doctor and discuss your options further. You can still choose to wait before committing to treatment, but you and your doctor, if that were your decision, would need to carefully consider how to stop the medication.

If you developed drug resistance to this regimen, you would need to switch to another regimen which has an excellent chance of complete viral suppression, but which would lack the convenience of one pill once daily.

So my advice is to stay on your medication faithfully until you see your doctor again, and then discuss your options with him or her.


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