Jan 4, 2008
I've gone through most of the responses -- thank you for taking the time to respond to frightened HIV-ers. I have two questions. I started taking Atripla in June 2007. My numbers were 232/34500 in May 2007 (before starting); 419/undetectable in August and 593/undetectable in November. My doctor is very happy with these results. I feel pretty happy as well especially since the side affects have been minimal. But I'm now worried about developing a resistance to the drug that seems? to be working so well for me. Is it inevitable that Atripla users will eventually develop resistance to the drug if they maintain dedicated to taking the medicine daily? In the same vein, the other night I went to bed (I take the medicine around between 10p and 12a daily) but I couldn't remember if I took it so I got up and took a dose. It didn't take long to realize that I probably had taken two doses that evening b/c I felt terrible! Did I do the right thing? My rationale was that I'd rather take a second dose then miss one...
Response from Dr. Sherer
Your doctor is right, you have had a fine response, with full viral suppression, a rise of 361 CD4 cells after less than one year, and minimal side effects.
I do think that you did the right thing, though I would prefer that you not overdose yourself. But, if you can't be certain that you took your dose on a given night, the best strategy is to be sure and take it. You might make it easy on yourself by simply checking a list when you take it, to prevent similar occurences in future.
No, drug resistance is not inevitable. The best evidence that you could go for many years on this same regimen without resistance, provided you maintain excellent adherence, is to be found in long term clinical trials of this regimen. After 5 years in one extended study of this regimen, more than two thirds of people who started on this regimen were still well controlled. If you are able to maintain excellent adherence, you could well have full suppression after 5 or more years on this regimen.
In full disclosure, I should also note that drug resistance can occur, even in the situation when an individual takes every ART dose as prescribed. Sometimes the reasons for this are unclear. Interactions with other drugs or incomplete absorption due to intestinal conditions could lead to low drug levels and drug resistance.
In the event of resistance to this regimen and virologic failure some time in future, the good news is that there are other fairly simple and well tolerated regimens that can offer complete viral suppression.
I urge you to talk to your doctor about your concerns and this response.
Resistance test accurate?
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