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Not Undetectable

Apr 29, 2001

Dear Dr.

Hiv positive since 03-97, at that time vl 50k, tcells 350. Was on Viracept and Combivir and t cells went as high to 600 and vl was undetectable till the new ultrasensitive test came out, vl went from 1100 to 8000, until 08-00 vl went to 25k,tcells 450. Found out have resistance to 3tc and Viracept. Started new regimen of Sustiva,Zerit,Ziagen in November 2000. 1st results in January 2001 came back vl at 225, tcells 500. Last test in March 15, 2001, vl at 72 and tcells at 580. My question is should'nt my VL be undetectable or what can I do to make it undetectable, I have not missed any doses, or how much longer does it take to bring it to undetectable. Thank you very much for your help.

Response from Dr. Holodniy

The lost response from your first regimen is predictable, as are the resistance to two of the three drugs. Your response to your second regimen is also consistent, and I am not concerned as to the response, yet. Sometimes it takes a few months to get to undetectable (<50) levels. If on your next visit, your viral load is still stuck above 50, you may need to evaluate your current regimen. It is possible that you developed some AZT resistance before, which was below the level of detection for the resistance assay, but is now affecting the activity of both zerit and ziagen, which it is known to do. MH

PCR >400 vs. PCR > 50 copies
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