Question
My doctor in Florida threatens stopping Atripla for bureaucracy….
9 January 2018. Related: Access to treatment, All topics, Resistance, Stopping treatment.
Hello there! I have been on Atripla for five years and just moved back from NYC to south Florida. I also changed my health insurance and my previous doctor’s office didn’t issue a new prescription. They sayed:”New Year, New Rules”.
They required a new blood test and a new visit to my Doctor BEFORE issuing a new prescription. I will be without my medication for 30 days!!! They didn’t ask for a previous blood test, nor wanted to have my medical files, nor talked to the doctor in NYC.
I told them they will be responsible for any further medical complications. IIt made the atmosphere very bad… Bureaucratic people who value more rules and papers than people! Do I have any alternative?
Answer
Hi
Thanks for getting in touch – and for highlighting the wealthiest country has a very difficult model of care. The situation you describe would be unthinkable in many other countries, because of the medical implications from stopping treatment.
These include:
- Within a week, your viral load will be detectable again and over the next few weeks it will be increasing to pretreatment levels (ie to what this was fiver years ago).
- For some people (roughly 1 in 20) this can involve seroconversion symptoms.
- There is a similar level of risk that you might develop drug resistance during the first week as drug levels drop below a minimum safe level.
- If your CD4 count was ever very low, a break in treatment, will know it back down again.
- Also, and in the US this is especially important, having a detectable viral load makes your infectious again to partners.
I am sorry that I don’t understand the many complexities of the US health system, but it is worth trying all options.
- For example. could you old doctor not just send a new prescription?
- Use a rapid fingerprick HIV test to get the new process started today.
- Perhaps a local community HIV organisation with a clinics might be able to find a month of meds to cover you. Many doctors get free sample they can sometimes used for patients.
- Perhaps a large hospital might have had drugs returned from someone who has changed treatment, that they con’t re-issue, but that a doctor could give you. In a pinch, even 20 pills would be enough because you would be okay taking Atripla during the week, with two-day breaks at the weekends.
- Do any of your friends have extra meds? Either for this or similar combinations.
- Do hospitals in Florida provide free PEP? If yes, an HIV negative friend could access a month of treatment if they say they recently had a high risk such as a condom break.
- Contact one of the national support lines (if they are still running) – perhaps from Project Inform in SF or GMHC in NYC.
- Perhaps post a request for help message to online discussion groups, such as at www.poz.com
You are right that this sounds like a crazy system. Please try all options.
If you are forced to take the break, you will probably be okay, but that forcing you to take this risks is not good.
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