expected/acceptable viral loads after high baseline
Jun 18, 2000
dear dr. holodniy,
thank you for this wonderful service, by the way! I have been on haart (d4t, 3tc, sustiva) for 7 months, and have been coming down from >500,000 copies, t4=14 (baseline in early December), to 200 copies and t4=250. My physician is now concerned that I am still 'detectable' and wants to add a 4th med to my drug regimen. my last vl was 330, so it is still coming down (granted, at a much slower rate than before). question: is the 6-month cutoff for becoming 'undetectable' applicable in my case? what should be my viral load goals? what would be the disadvantage of sitting tight and just continuing to monitor my levels for a few more months? I feel like I don't want to use up all the resources just yet. are my chances of long term suppression diminished by not getting to less than 50 copies in 6 months considering my high baseline? and actually, why the huge difference in suppression rate between the first months and the last months? I am hoping for a sound second opinion... thanks.
Response from Dr. Holodniy
You are asking all the right questions. You have had a fantastic response, but like your doctor, I am concerned that viral reduction has stalled. Your goal, as with all patients, should be to get to < 50. The 6 month rule is purely arbitrary based on observations made in a couple of big clinical trials. We do know that people who don't make it down to < 50 copies, are at great risk for developing virologic failure, as a result of resistance development from ongoing replication. You might want to give it another month, but if the news is the same, I would go for the additional agent.
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