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Is it a blip? Or is it resistance?
May 12, 2008

Dear Dr. Sherer. I would love to get your opinion. I am on triple combination therapy with Sustiva and have been on it for just about a year. I started treatment and my viral load plunged to zero in two weeks. It stayed undetected except for one blip up to 72 which then went right back down. I believe my adherence has been really good. Never missed a single dose, not one.

Okay here is the timeline leading up to my concern. First I got the flu this season and was laid up for about 10 days. On a Monday and went back to work. That very Saturday, I forgot to take my meds for the very first time. (I regularly take my meds between 11PM and 12 AM.) I woke up at 10 AM and immediately realized what I did and took the dose. Then continued as normal.

That following Wednesday, 4 days later, I went in for blood work. Viral load came back at 406! I am now very worried. Did I really screw up? Or could it be a blip? Could it be caused by the flu prior to that?

I would love to get your impute... A recent blood test came back with a viral load of 406. It was taken on Wednesday. Some background. The Saturday night before that very Wednesday, I forgot to take my meds for the first time before going to sleep. I woke at 9 and realized it, and immediately took them. I then continued normally that night. This is the first time and yet do you think it is a sign that I have acquired resistance?

I should also add

Response from Dr. Sherer

For now, its a blip. You have had a record of excellent adherence, and a single lapse is very unlikely by itself to lead to medication adherence, particularly in someone like yourself who is fully suppressed at the time.

A viral infection such as the flu is well known to cause a transient increase in your viral load, so you should just continue your excellent adherence and await the repeat lab values. If you need to, you can call your doctor and arrange for an earlier repeat viral load, so that you can ease your concerns, but I don't think its necessary, as long as you have returned to your excellent record of taking every dose as prescribed.

Resistance with Atripla
Late by 4 hours ?

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