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viral load not going down...
May 11, 2008

Hi there.

I was diagnosed in March and started to take Atripla. Since then, being two months now, the viral load has just gone down but not to the point where I am undetectable according to the dr. and he doesn't know why. He keeps asking me if I am skipping out on my Atripla. And I am taking this med every night without fail. My dr. did the resistance test and I am ok with that. But the viral load just doesn't seem to be going down and it's been 3 months and I am still detectable. What do you think it is now?

Response from Dr. McGowan

I am very glad that you have been able to take your medication every day without fail. That is the first step for success and helps to sort out your situation, since missing doses is the most common reason for not achieving an undetectable viral load.

It may take a longer time for the viral load to reach undetectable if it started out at a very high number (in the hundreds of thousands or more). The initial drop in viral load in those cases can be very fast, but then slow down over several weeks. If by 12 to 16 weeks the level has not reached undetectable, then the current treatment might need to be reevaluated, especially if the viral load is going up at any point.

It is important to know if a viral resistance test was done before you started medications. If so (as you seem to indicate), finding resistance to any of the medications in Atripla could cause it to fail early. It is also possible for the virus to have resistance to medications that does not show up on the test. The test samples some of the virus in the bloodstream but may miss a resistant virus if it is only present in very small numbers (less than 1 in 5 of the overall virus in the body). Even though the test may miss the resistant virus, it can cause the treatment to fail.

It is very important to keep taking your medication as you have. Return to have your viral levels measured during this time to be sure the level keeps going down, and to allow you to react quickly if it bounces back up.

Good luck,

Joe


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