ATRIPLA SEEMS NOT TO BE WORKING

Question

Hello, let me say first of all thank you for all you do for folks like us who have been diagnosed with HIV. I have been on Atripla for 3 months. My latest viral load is 420000 with a cd4 of 10 whereas my initial VL was 322000 with a cd4 of 0 at the beginning of Atripla. My MD called as soon as the current VL came back and I went to have a repeat VL and a genotyping done and am awaiting those results. It is sort of disheartening that one or more component of the Atripla is not working especially after being strickly adherent to taking my Atripla everyday and on time everyday. On top of that,I am back at work after a really life threatening bout of PJP having been hospitalized for 3 weeks which in fact was my initial diagnosis of being positive, seemingly rebounding great and feeling fantastic. I do take the recommended Bactrim and Azythromycin as propylactic therapy to keep PJP and MAC respectively at bay. I have come a long way and the journey is not over knowing that the goal is to get my VL down to let my body recover itself. So, with that brief history and knowing that the genotyping will determine my next options in regards to treatment, what has been your experience and next line of recommended therapy for folks like me whose initial treatment on Atripla seems to be not budging the VL?

Answer

Thank you for your post and I hope you are feeling better after your hospitalization.

I would definitely wait for the next test results. I assume you had a "baseline" resistance test done. If that showed susceptible virus it would be very unusual to not have an initial drop in viral load since the initial decline is seen when the susceptible virus is killed off and only later will any pre-existing resistant virus rebound up. By 3 months the resistant virus that may have been transmitted initially would have time to grow out.

In these cases the virus usually has resistance to FTC/3TC and probably efavrenz. This would still leave protease inhibitors, integrase inhibitors, possibly etravirine (a new NNRTI) and possibly the CCR5 antagonist maraviroc. Also tenofovir (truvada) usually remains active. So there should be plenty of good options to knock this virus out.

Best to you,

Joe