Q and A

Question

What is the risk of resistance from a late dose of Atripla?

Hi I’ve been on Atripla since early April 2011.

My last three viral load and CD4 results were: VL 277,750; CD4 468 (March); VL 3,458; CD4 550 (April): VL 1,060; CD4 700 (May).

The problem is I was late taking my dose last Wednesday. I was one hour and 45 minutes late. A stupid mistake caused becasue i was in a theatre & had to switch off my alarm. I completely forgot but took the pill straight away I remembered.

This is the only time I have been late but I am worried about resistance developing becasue I am not quite undetectable yet.

Please let me know what to expect and the chances of resistance. And how soon I will know if resistance has manifested.

Answer

It is good to get into the habit of aiming for the same time but one late dose over three months will not have done you any harm.

The three drugs in Atripla probably give you a good window period of at least two hours in which to take them without any problems. When starting out, for the first three months or until you viral load is undetectable, if is always good to aim for the same time.

Once your viral load has been undetectable for several months, even missing an odd dose completely, is unlikely to cause resistance.

A study called FOTO (Five On Two Off) followed a small group of people who were taking Atripla and who had undetectable viral load. For the next year they took Atripla only on week days (five-on) and not at weekend (two-off). Viral load stayed undetectable (less than 50 copies/mL) throughout this study.

I’m not suggesting missing doses routinely or copying the study, but the results should take some of the stress out of an occasional accident.

This study was specific to the three drugs in Atripla, which all achieve high concentrations that generally leave the body slowly. Many people in this study would have had active drug levels even when they were not taking the weekend doses.

You are getting a great response from treatment, and your next results will probably be undetectable.

See also this Q&A.

8 comments

  1. Lisa Thorley

    Hi lievie,

    Though not ideal, its very unlikely that this will cause your friends viral load to rebound. This is because it takes a week of missing meds for this to happen. She’s going to be fine.

  2. lievie

    my friend travelled and forgot her ARV tablets for two days and only took it on the third day , she has an undetectable viral load this is the first time this happens what are the dangers

  3. Roy Trevelion

    Hi Panicked,
    Accidents like this can happen. But now you’re back home you can talk to the clinic about what happened. You can ask for tests to check for viral rebound and for resistance.

  4. Panicked

    Hi, I forgot my Odimune and went to Brazil for 2 weeks as I travel for work. When I got there they didn’t have the same meds I take and I couldn’t take what they had. I went all over looking for combination that I take. I’m scared that I might be resistant to meds now.

    Please advise

  5. Roy Trevelion

    Hello Worried,
    It can depend on how many days you are going without meds. If you are flying to another part of your country can you contact the nearest clinic and tell them you accidentally left them behind?

  6. Worried

    Hello .

    I am on Arv since 2012 and my viral load is undetectable. I’m going on a 5 day pill and i accidentally forgot my mediacation in the car as i’m flying. Am i at risk of resistance ? I’m super worried now

  7. Bruno

    Hi, I have been taking Atripla for one month already. I’ve never missed a pill, but I have taken one dose or two after having had lunch. Can food or a glass of wine interfere with the medication? Can alcohol or food too close to the pill taking be responsable for developing resistance?

  8. Robin Jakob

    Hi Bruno,

    Alcohol does not have an effect on HIV medication of any kind. The food will not reduce the levels of drugs but may actually increase them. It is usually recommended that you take Atripla either on an empty stomach or with a low fat meal. This is to avoid drug levels getting higher and causing more, or worse, side effects.

Comment

Your email address will not be published. Required fields are marked *