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Atripla and Resistance
Jun 16, 2007

Hello Dr, I have been taking Atripla since Jan. 2007 and i have very little side effects and my viral load has decreased from 98,000 to under less than 300 as of April 2007.My cd4 also raised from 335 to 455 in that same time frame. I have not missed a dose since being prescribed Atripla. Here is where the problem is. I started a new job recently and i only have enough pills to last me until July 14, 2007 and my new health plan won't kick in until August 1, 2007 and for some reason my old insurance changed and atripla is no longer covered. Is there something i could do within that two week window if i don't get this health coverage settled. I was thinking taking half a pill one day and then a whole pill the next so the atripla will remain in my system instead of running completely out and have nothing no meds for two weeks. Will this cause resistance?...Please Help

Response from Dr. Daar

Thank you for your post.

The one thing I feel strongly about is that you not take half a pill to make the medications last longer since this will put you at signficant risk for developing resistance. I suspect that if you talk to your provider you will find other ways to get your medications. It seems unusual that Atripla would not be covered. Perhaps they do cover the components of the regimen tenofovir (Viread), emtricitabine (FTC), and sustiva separately. Look into this possibility or if there are other viable agents that you could access during the gap. As long as your viral load remains undetectable you will be able to switch back to Atripla when your insurance kicks back in.

If for some reason there is no way you can continue therapy during the two week gap you need to talk to your provider now as to the optimal way to stop therapy. It is a little complicated but you should be able to safely do this so that no resistance develops and treatment will remain highly effective when you are able to restart.

Best, Eric


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