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Still not Undetectable
Jan 23, 2013

Good Day Doctor I am a bit worried that the Atripla that I am taking is failing, or that I have become resistant. I was diagnosed in May 2012 and started taking Atripla on the 8th of June 2012. My Viral load then was 894 000 (very high) and my CD4 count was 322. I have had no side effects on Atripla, only the odd vivid deam here and there. Yesterdays blood (18 January 2013) revealed that my CD4 was up to 701 and my Viral Load is 81.The previous time the bloods were tested in October my Viral load was 79 and and my CD4 was 749. Here is what is worrying me: Should I have not been undetectable by now? I have been really good at taking my pills, missed only once. That is a 99.7 % adherence rate.I have kicked myself blue over this, but it has taught me a lesson. I take the Atripla at 20h00 at night after I have had my supper at 18h00. Please can you advise me. My Doctor thinks that we should go over to another combination. She wants to see me again in three weeks, so that that we can do another Viral Load test .Hoping to hear from you soon.

Response from Dr. Wohl

It could be that you a one of those people who has low levels of HIV detected in their blood despite great adherence to HIV medications (99.7% is basically perfect and more than enough to suppress HIV) and no viral resistance to the medications. In such cases, it is thought that the virus being detected is HIV that is moving from one place to another and that this is not a problem of drug failure. There have been studies of such folk where powerful HIV meds were added with no change in the low level HIV levels seen.

So, you and your doc have a couple of options. You could stay the course and remain on Atripla and follow your counts. Or, you could change to another regimen like a ritonavir-boosted protease inhibitor plus Truvada and see if that changes anything. If you do change and still have low level virus, this proves this is trafficking virus and not something to worry much about.

Of course, make sure your doctor ordered an HIV resistance test prior to your starting the Atripla and that no resistance was seen. I suspect that is the case but good to check.

DW



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