Question

Do I have resistance to Atripla from shift work?

20 October 2018. Related: Adherence, All topics, Newly diagnosed, Resistance, Southern Africa, Starting treatment.

I am afraid I might have developed resistance to Atripla?

I was diagnosed HIV+ in May 2018 with a CD4 count of 400 but I was working shifts then. I had to alternate times between my pills. Some days I’d have 12 hours between doses during change of the shift.

Then because I was in denial I went for 2 weeks without medication as I was suffering from depression.

For the past 2 months I have been adhering to treatment, my CD4 count is now 474 and viral load is 59. 

I am still struggling to gain weight, eat and sleep. I feel faint as well sometimes and I get tired easily. All my vital organs are functioning well and my TB test came out clean. I work nightshift and I struggle to sleep and eat. I recently developed sores on my tongue.

Could I be resistant?

Answer

Answer: Simon Collins

Hi

Thanks for writing and for letting us post the answer online.

Your email raises lots of important questions.

First, you were only recently diagnosed, so a lot of this must be new and perhaps difficult. It will get easier over time though.

Second, you were depressed for  a while – which is common after finding ot you are positive. But your meds are Atripla, and the efavirenz side effects might had caused the depression too, or made it worse.

Thirdly, working shifts on Atripla is not recommended in the UK, because your the side effects of mood swings are more difficult because of the time changes. Atripla needs to be taken just before bedtime, so changing the times you sleep for shift work is difficult.

Also, you said you are in South Africa, where Atripla is commonly used for first treatment,

One benefit of Atripla though is that the three meds in this pill last in your body for longer than 24 hours. This means that you can sometimes have more flexibility if you miss or are late with a dose, and more protections against drugs resistance.

More good news is that your viral load is so low – just detectable at 56 – that you are very likely to still be sensitive and able to use these drugs. So the answer to you main question is that your current viral load shows you were lucky and didn;t develop drug resistance.

The next big question is whether or not you want to continue to use Atripla because of the difficulties with side effects and shift work. This is something to talk to your doctor about. Tell your doctor that you are not sleeping properly and about your shift work etc.

It might be that there is an alternative combination, and whether this is easy to change to in South Africa. If this isn’t easy now, then very soon a new drug called dolutegravir will be available in SA.

This is a new HIV drug combined in a three-drug combination pill, so you could still just take one pill a day.The combination pill is abbreviated to TLD but sometimes it is referred to as TDF/3TC/DTG.

This page has more information about these meds in SA:
https://i-base.info/modern-art-for-africa

It is good that your TB results are ok.

Please talk to your doctor about anything else, including your tongue – but this might not be related to HIV.