Dec 24, 2005
My Thai wife and I live in Asia. She contracted HIV after costmetic surgery in 2001. AZT was first prescibed but she seemed intolerent to it and so a regimen of Crixivan/Norvir Stavir and Videx was taken up. At this point she had a CD4 count of 180 and VL of 28,600. Over the next year blood tests in Nov 2002 showed her CD4 count had dropped to 170 and VL about the same. The doctor was unhappy with this progress and following a genotype test, assessed that Crixivan and Norvir were not working but the other 2 were. He then changed her regimen to Efavirenz (200mg twice daily plus the same Videx and Stavir ( plus daily Bactrim antibiotic 80mg). By mid-2003 her blood test showed CD4 210 and VL 4170. She remained on this regimen for one year when the blood test in mid-2004 showed CD 291 and VL 8600. The doctor again seemed unhappy with these results and changed her regimen once again to 'Kaletra' ( 3 tabs morn and night), Videx and Lamivir (150mg twice a day). About 6 months later her blood test of early January 2005 showed CD4 count 227 amd VL up to 32,000. He then advised her to discontinue any drugs (for 1 month) while he conducted a genotype blood test. The recent results of this are apparent resistance to all the meds?? We have to go and see him soon and I think he is contemplating taking her off all meds for some months. This worries me and I note in various other answers and articles that it may be better to continue with some regimen or part there of rather than stop all together ( I think you referred to viral "fitness). Before seeing him I'd like to hear your opinion of the previous history, strategy followed to date and possible alternatives for the immediate future? After reading so many other "stories" and "cases" in these pages I get the feeling that she might have been doing OK previously and that the doctor may be striving for excellent ( no VL, high CD4) results.
As an aside I remain HIV negative despite a very active sex life - great testimony to the use of the humble condom!!
Response from Dr. Holodniy
This is a very difficult question to answer without having seen the resistance reports. It is likely she may have developed resistance to all the meds that she has been on, given the fact that she never had an undetectable viral load and kept taking the meds in the presence of detectable virus. There may still be some treatment options and a phenotype resistance test may also yield some additional information to determine which meds still have activity. Treatment interruption is controversial and studies have yielded mixed results as to benefit.
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