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still on holiday
May 1, 2004

Dear Dr.,

Im a 38 yr old m pos since 1997. hit hard and early. stopped meds last Oct. last VL 130,000 and CD4 at 577. I had resistance test last year showed resistance to 3tc and nnrti's. however, had another test done last week shows susceptible to all meds. What does this mean? can I take Sustiva again? Is their wild virus mixed with resistant virus? When should I restart meds. CD4 has never been under 500. My Dr. told me that even with a relatively high VL, that my CD4's were'nt being killed off quickly. Why?

thank-you in Denver

Response from Dr. Holodniy

Your resistance test last year provides crucial history for any future HIV med regimen you are likely to go on. The resistance is still present, and has faded into the background as a result of no current drug pressure. So, it is still there and it is highly likely that sustiva will NOT work. I agree with your doctor. Although we don't necessarily like to have people live those kinds of high viral load numbers, at least for now, your immune system is able to sustain an equilibrium between viral production, t cell infection and new t cell production. I suspect your CD8 count is quite high, telling you your immune system is mounting a vigorous response.



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