|A treatment failure?
Jul 28, 2000
Dear Dr. Holodniy,
I have been on Sustiva, Epivir, and Zerit for around a year now. I was undetectable until 5 mos ago. About that time I had a VL of 400, and 3 mos later a VL of just over 600. A Cd4 count hasnt been done in about a year. That was around 900. I wanted to change the cocktail, but my Dr. says I can still get some use from this cocktail even in a slow VL increase. DO you agree with this? If not, what would be a good next choice of drugs? I was on Viracept briefly, but quit due to the craps! Also, I was on combivir briefly, but quit due to anemia setting in. Thanks for all your good work! IN FLORIDA.
| Response from Dr. Holodniy
We are evolving our concept about these discordant responses (detectable viral loads with stable CD4 counts). It may well be true that you have a resistant virus now that is less fit and doesn't replicate and kill t cells as well. It is not unreasonable to stay on this regimen and follow both viral load and CD4 count closely. I have several patients in the clinic in this situation. If the CD4 count/percentage begins to drop, or the viral load increases, I would change. It sounds like your protease inhibitor exposure was short. If you need to change, I would use another PI or combo PI as the backbone and discontinue the sustiva and epivir as resistance to those two would be highly likely.
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