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Switch from Viracept to Sustiva

Jan 12, 2001

Hi Doctor,

I was switched from a combination Viracept/Combivir to Sustiva/Combivir, as I had gained quite a bit of weight in a short period of time. I was undetectable with Viracept. My viral load test came back at 450. I was assured that I should not worry about this, as sometimes one's body needs to get used to the new regimen. My helper cells did increase from 357 to 497 which the doctor indicated was a very good sign. He told me that I do not need to come back for 4 months. Does this seem reasonable? thanks

Response from Dr. Holodniy

You don't indicate how long after the sustiva was started the viral load was obtained. You also don't indicate when your viral load was "undetectable" whether this was using an ultrasensitive assay (lower limit <50 copies/ml) or a "regular" viral load assay (lower limit < 400 copies/ml). If it was the latter, then you already may have had "detectable" viral load, which was just below the 400 copy limit, in which case this is really no change. If you had an undetectable viral load with the ultrasensitive viral load test, then 450 would be significant, and somewhat puzzling as to why the increase. I have switched many patients with viral loads < 50, and not had these kind of blips unless there was resistance or poor adherence going on. The T cell increase is encouraging. You may want to suggest looking a little earlier.


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