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Would changing meds cause "blips"?

Mar 27, 2005

Dr. Holodniy - Diagnosed in 06/2000, started meds two years later in 08/2002 with Epivir, Sustiva and Videx EC. VL went from 600,000 to undetecable in 4 months while CD4 count rose from a low of 320 to between 500-600. CD4 percent in the high 20's to mid 30's. These numbers were fairly stable in the two years on this regimen. In 09/2004, due to a case of mild neuropathy in one foot, I changed meds and replaced Videx EC and Epivir to once a day Epzicom (Ziagen and Epivir) while remaining on Sustiva. First labs after changing meds showed stable CD4 count of 550, cd4 percent of 29, and CD4/CD8 ratio of 79 percent. However, VL showed up as 70. I know blips are common so didn't worry too much. However, second labs three months later now show a VL of 115, CD4 count of 619, CD4 percent of 34 and CD4/CD8 of 94. I have never missed a dose (have always been within two hours of the same time). So I am wondering, would the change in meds have anything to do with now having two labs in a row showing a VL over 50? If not, any thoughts of what it could be? I have read that the once a day Epzicom is just a good as the Ziagen and Epivir twice a day so don't know why that would matter. Your comments/advice are very much appreciated. Thanks.

Response from Dr. Holodniy

I certainly understand your concern. I agree it looks suspicious after the med change. But these meds should be equivalent in potency and I would not expect to see failure as long as you were adherent. I am not willing to call this failure yet and think this is still a blip. Your CD4 counts are holding steady, so I would just recheck again. If the viral load trend is up then I might consider adding another agent at that time.

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Unexpected CD4 % trend followup

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