Atripla, How long to become undetectable

Question

I've been on Atripla since 4/10, my viral load dropped from 23,000, to 15,900, 107, then jumped up to 510, then down again to 74in Sept,. ...my Dr. said to contiue on the Atripla and get lab work done in a month...I did VLis now 91 ....my last CD4 level was 336, but now down to 313....she is suggesting a change in treatment...My question is How long should one be on Atripla to become undetectable.....I've only been on it for 6 months

Answer

Hello and thanks for your post.

It's always reassuring to see undetectable viral loads. That said, depending on a number of circumstances, it can take up to 4-6 months to get there (except for regimens that include raltegravir/ISENTRESS, where viral loads reach undetectable levels very quickly).

In your case, I wouldn't be jumping ship from ATRIPLA so quickly-- I'd want to know if you've really been adherent to your medications; if you had a sinus infection or cold sore- things that can cause low-level viral loads. Was a baseline drug resistance test done? Could it be possible that you had acquired drug resistant (resistant to Atripla's components) virus? To me, a viral load of 91 is hardly cause to switch medications, but a time to regroup and make sure that all other factors are optimal.

Without knowing your virus' drug resistance pattern (only available for tests with viral loads greater than 500 copies), it would be difficult to plot your next treatment.

If you were my patient I'd probably advise continuing on your treatment, really work on the adherence, check for other infections or complications and repeat the viral load and CD4 test in 1-2 months.

I hope this is helpful and wish you well, BY