Hello Doctor

I have been on Atripla, my first regimen for one year. Im undetectable and 550 cd4. During the first 3 months, I forgot 3 times to take the pill. Two times I took it with 8 hours delay, and once 18 hours later.

Since then, I have never missed a single dose, (+- one hour).

After this 9 months of perfect adherence, and being undetectable, does it mean that I passed the risk of developing resistance?

Thank you very much

Manuel

Yes. Your fine results suggest that in spite of those few lapses, you have NOT developed resistance and that your level of virus suppression has NOT been compromised, and virologic failure has NOT occurred.

Congratulations. Keep up this excellent record!

You and other people living with HIV on ART should be aware that it is difficult to maintain an excellent record like this. I have had many patients who did this well for one year or for 5 years, only to have a major lapse in their adherence and to develop virologic failure and drug resistance.

Often this occurs because of some other major life event that interferes with the normal pattern of adherence. For example, a working man on ART loses his job and becomes homeless, and his normal life and schedule are so disrupted that he is unable to maintain excellent adherence. Or a new mother with HIV has trouble with her marriage and separates from her husband, and the resulting pressures of being a single mom while working lead to heavy alcohol use and irregular adherence. People change, as do their life circumstances, and its easy for the fragile system that people work out to maintain excellent adherence gets undermined or obliterated in a short period of time.

I tell these stories not to scare you, but as a warning that this excellent record that you have established will require your ongoing vigilance in order to be maintained. Don't take it for granted!

I urge you to talk to your doctor about your question and this response.