Hello Doc, I've been on Atripla for 10 months (i'm a naive patient), Undetectable VL just last 2 months, CD4 count now 400/20%, nadir CD4 was 55 on january this year with TB coinfected ( TB Meds stopped on July this year). I have rash on my face that couldn't go. I'm still considering to switch to Truvada+Isentress . Is Efavirens related to Rash? from your experience,do you think would be safe for me to switch to Isentress? and is that true with nadir cd4 count like me will still develop any other AIDS related malignancies in the future? ( let just say 7 to 10 years later?) Thank You

Efavirenz occasionally is linked to ongoing rash problems though that is not common (flare-ups of skin problems such as seborrhea or folliculitis seen with immune reconstitution-usually not drug specific). I am not confident that switch from efavirenz to raltegravir will improve the facial rash though that can sometimes happen. Low CD4 nadir is linked to increased risk for range of AIDS and non-AIDS problems later though how that risk is reduced once CD4 recovers (ie >> 350) and viral load is suppressed long term has not been well documented long term (ie 1-2+ decades)--good question and something that a range of current studies are looking into. KH