Couple questions

[Stone]

My brother has been HIV positive for at least 7 years.  He switched to Atripla almost a year ago due to issues with lipo but this did not improve.  He has continued to have an undetectable viral load and T cells in the 400 range however.  The problem is this, he doesn't take his med at the same time (many hours different at times) nor is it always on an empty stomach.  I am concerned but since his numbers are good wonder if it really is as big of an issue as I think it is.  His ID doc has also cut back the follow up appointments to every 6 months.  I wonder if this is safe, seems it should be watched a bit more closely.  My brother really likes his doc but I don't think things are followed as closely as they should be, for example I had to really push for kidney function testing and the only reason the MD finally did it was because I made it pretty clear that I was not going to quit harping until it was done.  My brother is very anticonfrontational so he will pretty much agree with anything even if it to his detriment unless I harass him enough.  I just want to make sure that the harassment is warrented.  Thanks! 

[Luke]

Is the harassment warranted? Yes and no.

Once you are stable on Atripla and have an undetectable viral load, the window for taking the drug is quite generous; so, provided that he isn't routinely skipping doses, I don't think you have any major cause for concern about the timing of doses.

Similarly with the empty stomach advice. Once you are used to the drug and have gotten over the initial burst of temporary side-effects, it really doesn't matter so much whether you take it on an empty stomach or not and the choice is very much dictated by the personal side-effect experience. I routinely take my Atripla at the same time as eating my breakfast and suffer no ill-effects.  

Keep being pushy about the kidney function tests though. They really should be done as a matter of routine.

[mecch]

I'm sure you love your brother.  However, have a talk with him and since you seem to know his HIV Specialist, have a talk with the HIV specialist as well.  The question is:  *Why am I so involved in my brother's relation to his doctor and his own choices about his HIV?"
If the Dr says you don't need to be so concerned, and your brother says you don't need to be so concerned, back off a it, take some distance.
Seems like your brother is adherent and doing well enough...

If you really feel like he is receiving below par treatment, you're going to have to explain to your brother why, nicely. I would avoid any sort of HARRASSMENT on any of these issues, however.

[Stone]

Thanks for the responses.  No I don't my brothers HIV specialist, I got on my brother quite extensively and he relayed the info during his appointments.  Made me the heavy and quite honestly I am OK with that.  As far as why I am so involved and / or concerned the answer is simple.  I tried it the other way and my brothers partner (who was also like my brother) died.  I tried to get Mark to go to a larger facility for treatment and a second opinion.  He refused, got angry, and after about three attempts I dropped it.  Mark did finally end up getting to the larger facility unfortunately it was in an ambulance and it was too late.  The doctors said that maybe they could have done something had they gotten to him sooner.  I now carry guilt and regret.  I wonder if I had just tried a little harder, could I have gotten him in the car had I just pulled up and said "lets go"?  I should also say that I am a registered nurse so sometimes I have a little too much education.     

[mecch]

Oh how sad!
Well, good thing your brother has you...