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Treatment Switch
Aug 30, 2009

Dear Doctor,

already submitted a series of questions on my ordeal since June of last year, but here's a quick recap. Was diagnosed in Nov 04 (VL 100K, CD4 450, approx. 28%) and started therapy in June 07 (VL 600K, CD4 260, 12%). At the time of my diagnosis no significant resistance was detected. First regime was Truvada and Stocrin, which I had to interrupt after 2 weeks due to a skin rash. Switched imnmediately to Truvada and Reyataz+Norvir, which did not cause any apparent side effects. Reached undetectablen in Nov 07 and stayed there until June 08: from that moment on, have been consistently detectable, with VL fluctuating between 50 and 120, with a couple of undetectable thrown in for good measure in this timeframe. In January my doctor tried to add Abacavir to the regime to no effect. Last test (early August) revealed VL 57, CD4 930, 32%; I enjoy excellent health, all indicators (lipids, etc.) in my blood tests are deemed excellent, am 100% adherent. Now my doctor recommends I switch to Truvada, Prezista, Norvir and Isentress. I'm happy with Prezista, given what I've read about it, but I'm skeptical about Isentress. Is it not too much at this stage? Would it be possible to try with just Prezista and eventually add Isentress later on? In case I reached undetectable again and stayed there long enough, could I get rid of Isentress later on? Many thanks for your feedback, which is always highly valued. G.

Response from Dr. Holodniy

I am not sure I would react to the viral load of 57 by adding issentress to the mix now. Your current regimen seems to be doing the job, given your excellent CD4 count response. I understand that some providers want to get down to as close to zero viral load as possible (even though you can't measure that) by being aggressive with more agents, and perhaps pulling back at a later point. I don't see anything to suggest that your regimen is failing you at this point.



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