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Oct 31, 2000

i was taking viracept,combivir, and sustiva. at the time my vl was 400,000 and my t-cells were 12. that was 4/99. since 8/99 my vl has been undetectable, and my t-cells are 200 since 8/00. my dr. and i decided to stop the viracept, to make my regiment easier. figuring my vl can remain undetectable on the remaining meds. my question is i go for bloodwork soon, and i'm wondering if i should be worried that my vl may rise? or if it does is that normal, and it will go back down? i really like this combo., no diahrea.


Response from Dr. Pavia

Dear Russell,

The idea your doctor proposed, starting with 4 drugs to make absolutely sure you get a good response and then dropping to 3 after a year is sometimes called "induction maintence" It is a very attractive idea that makes good sense, as long as when you drop down the regimen is strong enough. Combivir/Sustiva is likely to work very well for most people. The original studies of induction maintenance dropped people from 3 or 4 drugs to just 2 drugs, which didn't turn out to be enough. There are no great studies of the 4 to 3 approach, but lots of doctors and patients have tried it, and it seems to work very well.

For you, the proof is in the pudding. That is, if your viral load stays down, the approach is working. In general, if your viral load goes up, say above 2000, that is not what you want to see. As I have said before in this space, "blips" of up to about 200 may not be important, and you may have a blip and go back under control. I am glad you like the new regimen, and if the viral load stays down, it sounds like a good way to go. Make sure to discuss it with your doctor if you have other questions.


Andrew T. Pavia, M.D.


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