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What to do
Oct 4, 1999

I have been hiv+ for 5 years. When first diagnosed, I was put on AZT,

but had to stop treatment after 3 weeks due to severe lethargy and

nausea. Soon after, viral load testing hit the market. At the time, I

had VL=250,000, t-cell=350. I was put on Crixivan, Zerit, and Epivir,

resulting in VL=undetectable and t-cell remaining the same. This

remained for about 1 year, at which time I had 2 bouts with kidney

stones. At that time (spring 1997), my MD switched me to Viracept,

Zerit, and Epivir. For about a year, I had VL=undetectable and t-cells

fluctuating from 350, 295, and 425. Over the past year, my VL has

become "visible", ranging from 4000 to 5000. Triglycerides also started

to elevate.

In my most recent quarterly tests (last week), I had VL=25,000 and

t-cell=325. Also, my triglycerides are 2500.

My physician has given me 2 options:

1. switch to Sustiva and dd4 now

2. stop taking my current meds, take no meds at all, and wait for a new

drug (Abbott 378) which should be released in 6 to 12 months. (doing

this would allow me to keep the Sustiva as an "ace in the hole" for the

future)

My question(s): This is all very confusing! What should I do? Is it

safe to stop all treatment and wait for new drugs? Should I continue to

take my current "cocktail" until the new meds come out? Are there other

options? What about alternative therapies (selenium)? Please help!

I thank you in advance for your advice - in this world of hiv, it's good

to know that we can count on you! Looking forward to your advice.

Response from Dr. Holodniy

In general, your CD4 count has remained fairly stable over 5 years. Although I don't have the benefit of resistance testing in you, your virus is more than likely resistant to 3TC/nelfinavir and probably indinavir, which means probably most other PIs. You were on AZT for too short a time to develop resistance, and it is very hard to show d4T resistance has developed. STopping all meds now has it's proponents. The danger is that you may get virologic rebound back to your pretreatment levels which could chew up your T cells faster. It alot harder with salvage regimens to get to undetectable from 250,000 than it is from 25,000. ABT-378 alone will not be the answer and you will need to combine it with something else.Your lipids will get much better and you won't have the pill burden for awhile. By using a sustiva regimen now, you will with almost a 100% certainty get to a viral load of <50 and improve your T cell count.Selenium by itself will not do it.

MH



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