Question
Will I have resistance from these missed doses of Atripla?
15 July 2011. Related: All topics, CD4 and viral load, Changing treatment, Resistance.
Hi,
When I was first diagnosed HIV positive, I suffered from anxiety and was neurotic about my regime. Since I have had therapy and become more accepting of my HIV, I have become more relaxed and careless about my meds. I have been missing a dose of Atripla about three times a month on average.
Now, I am currently trying hard to improve my adherance, but I am worried that I have already developed resistance.
My viral load was undetectable the last time I got my blood results. My pharmasist says I will most likely have a rise in my viral load count, but that it will not necessarily mean I have developed resistance. I find this confusing as I thought a rise in my viral load count would mean I have developed resistance.
Do you think I still have a chance to change my adherance before it’s too late to continue with taking Atripla?
Answer
Hi
Please see this similar Q&A. The reference and link to the FOTO study is an example of why you may still be okay.
Because the three drugs in Atripla take a long time to leave your body, if you miss three separate doses each month, the drugs levels may still keep the virus suppressed without developing resistance.
If you are missing three consecutive days in in a row – then your risk is more serious, and trying to get back to better adherence is important. At the end of the third day you would be a risk of resistance much more easily. If your viral load rebounded after these longer breaks, then it is likely to be with resistance virus.
Also, think about why your feeling changed. Accepting your diagnosis and yoru successful response to treatment, means you can think about a normal lifespan again. In a funny way that can also be strange after the shock of a diagnosis where you think a lot about mortality.
Because of the way you are worrying, I’m sure you will be able to get this back under control again. It is good that you feel confident to have these open discussions with your pharmacist.
Cohen C et al. The FOTO study: The 48 week extension to assess durability of the strategy of taking efavirenz, tenofovir and emtricitabine Five days On, Two days Off (FOTO) each week in virologically suppressed patients. 5th IAS Conference, 2009. Abstract MOPEB063.
http://library.iasociety.org/AbstractView.aspx?confID=2009&abstractId=3046
Hi Sidney, thanks for your comment and you son is lucky that you are also there for him.
Although this is not ideal, sometimes this happens in prisons and it this only happened the once, everything should still be okay.
After two months without meds, your son’s viral load is probably going to be detectable now. However, his immune system – measured by the CD4 count, will stay strong for a while until he can start meds again.
His response will also depend on how high he viral load was before he first started treatment. Also, on how low his CD4 count was.before treatment. This is because he will slowly return to these levels.
If his CD4 count was ever lower than 200, then get the meds started again is more important. It is also more important that your son wathces out for any new symptoms, for example, thrush in the mouth, persistent coughs, rash or fevers. In this case the doctor should become involved, but this will hopefully not be needed.
Most people are fine for a few months off-meds and they respond well again when the meds are restarted.
My son has been taking Atripla for several years now and was undetectable he has been in jail now for 2 months without his meds. I am so worried for him that he will get really sick.
He ordered his meds but they sent the wrong meds and it’s taking a while to get the right meds What will happen to him? I am a worried mom.
Hi Pozz,
HIV log values are used so that large differences in changes to viral load can be shown on charts and diagrams. This makes the viral load easier to use when looking at treatment results. There’s more information at this link.
Being undetectable means that HIV cannot be transmitted to your boyfriend even if you don’t use condoms. But please ask your doctor what HIV log=na means.
A CD4 count of 849 is strong. And if your doctor says you are undetectable it means your HIV treatment is working well.
Hi
I’ve been on treatment for quite sometime, maybe from 2016, and I’m undetactable,my last month result came out saying my CD4 count was 849, and HIV log=na ( what is the meaning of this n/a?)
I’m now worried cause I’ve missed a dose once or twice, will this not cause hiv transmission to my boyfriend?
Hi Alworried,
It’s great that you’re undetectable and have a strong CD4 count. Atripla looks as though it’s working very well.
Taking the meds separately should not have any effect on your treatment. That’s because the same active meds are in both Atripla and the separate pils.
However, please check that you’re taking all three meds from Atripla. They are, efavirenz, tenofovir DF and emtricitabine (also called FTC). It’s possible that FTC is also in the tablet with tenofovir, but you could check this on the bottle or leaftlet.
Hello I have been on Atripla since Feb 2018 with a CD4 849 and VL of <20. My Dr. Currently got me off of Atripla due to them not having any in stock and now I take the Efavirenz and tenofovir disoproxil fumarat separtely. Will this affect me for not taking the Atripla any longer? She changed it, do them not having any in stock and since they are purchased through our government here in Central America and donated, I have no choice but to start taking it. Will these effect my health?