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VL creeping up

Jun 25, 2005

I have been on meds for a year. First Sustiva/Combivir then switched to Sustiva/Epzicom last October. My CD's are in 600 range but my VL is creeping back up from low of 79 to 144 to now 600 in last 9 months. Do you think adding Viread is a wise option, or would you just keep the same regimen for now?

Response from Dr. Holodniy

This may not just reflect a blip, but ongoing replication in the presence of HIV treatment. Because sustiva and the 3TC (epivir) in epzicom only need one mutation to knock them out, a mid course correction may be in order. The viral load is low enough that most labs would not perform a resistance test, although that is info you would like to have in order to know exactly what to do next with your regimen. The addition of tenofovir to intensify the regimen may be one strategy. In patients who were started on tenofovir, abacavir and 3TC, WITHOUT sustiva, were found to have a high early failure rate, which is still unexplained. This is slightly different than your case, but there may a tenofovir/abacavir interaction that we don't understand yet. Alternately you could intensify with a protease inhibitor for a short time to get you to undetectable level or just wait and see what the next numbers look like.

Very Interesting Thought
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