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Viral Load UP. Crixivan/Combivir, Ziagen, or Sustiva?

Jul 12, 1999

Dr. Holodniy; My lover is HIV +. I try not to worry too much, and I do try to be current and educated on the literature. However, I am concerned. His viral load is up to over 52,000, and his CD4 is steady at 400. His treatment began with just AZT. In 1996 he was prescribed Norvir with AZT. Later that year, his Doctor prescribed Crixivan with 3TC and AZT, then later to Crixivan with Combivir. These treatments worked well until about 6 months ago. His Viral Load has gone progressively up from undectable levels to 23,000 6 monthsd ago, and now it is over 52,000. During that time, the CD4 counts have remained consistent at around 400-500.

I have these questions: 1. Will a treatment regimen switch FROM Crixivan/Combivir TO Ziagen and Combivir lower his Viral load? 2. Is it possible that he has become resistant to the Protease and/or the AZT and 3TC combo? 3. Would a treatment of perhaps Sustiva and a Zerit/Epivir combo be more effective?

I am new to the NNRTI and d4T treatment options, and I truly want to be aware of what is best for him. I am not a Doctor, but I would like to just have an idea as to where his treatment may need to be headed. Thanks in advance for your expert view. As an aside, THANK YOU for your contributions and research. You have helped many. :-)

Response from Dr. Holodniy

1. Probably not much. He is more than likely resistant to 3TC and probably AZT. The mutations which cause resistance to these meds will likely cause resistance to ziagen. He probably has developed some resistance to the protease inhibtors as well. Norvir and crixivan are linked by having the highest level of cross resistance between them. A resistance test here might be helpful in flushing out which of the old medicines he is resistant or cross-resistant to. It would be unwise to add only one new agent. A sustiva/ddI/d4T is a possibility. MH

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