Nov 19, 2007
Hello Doctor I was diagnosed in Sept 2006. I was undetectable and my cd4 was 793 but in Feburary 2007 my cd4 dropped to 208 and my viral load to 3000. I started on Atripla in March 2007. My appetite has decreased a lot over the last year and my weight keeps dropping. The doctor put me on supplements (both ensure plus and health bars daily) in addition to trying to eat more. After two months on Atripla, my cd4 was 583 and vl undetectable again. The VL remained undetectable until now when it showed at 64. My cd4 was 925 in June and 831 in August but dropped to 533 now. The doctor mentioned maybe doing another genotype and maybe switching meds. Nothing definite yet. I am to see him again in two weeks. Do you think the vl slight increase and the drop of 300 in the cd4 merit looking at switching from the Atripla so soon? It sure seemed to work well from the start. I will take whatever meds the doctor determines but was curious is something else could be going on. My doctors don't mind my doing research or asking other opinions. I am very fortunate to have a great HIV doctor but every time the numbers change I get scared. I also am a database admin and have a very stressful job. Thanks for any opinion you can share. I love this website.
Response from Dr. Conway
Low-level virolgic breakthroughs such as the one you seem to be experiencing must be carefully evaluated. I would first want to know if you have been missing pills at all or if you may be taking other medications that may reduce the blood levels of the antivirals, especially the efavirenz. If either of these things can be addressed, you may be able to fix whatever problem exists quite simply. If not, it may be difficult to do a resistance test with such a low viral load. What I might do is to make sure you take your Atripla faithfully for a few weeks and then repeat the viral load and CD4 cell count before I went ahead with anything else.
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