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Time for STI ???
Feb 18, 2002

Dear Dr Boyle, i was detected pos in oct 2000 ( vl 33700, cd4 243) and have been on nevirapine. stavudine and lamivudine till date with 98 adherence. In Mar 2001, vl 29600. cd4 243, then july 2001, 25400 and 415. Now 2 days back vl was 24300 and cd4 640. My que is , can i have drug holiday .... monitor vl and restart when cd4 is near 350. i have been keeping very good health( never had OI's) since starting meds without any side effects. If not what kind of STI can i take.. 7 day off/on. 3 weeks off/on or any other? Thanks in advance.

Response from Dr. Boyle

First, you need a genotype to define your current resistance, which is likely to include both nevirapine and lamivudine, and that should be done while you are on therapy. Second, it is ok to interrupt therapy with careful monitoring of your CD4+ T cell count. It is likely that off therapy you will return close to your nadir within a matter of a few months or so, but you may not. If you return to a CD4+ T cell count <300, you should probably restart therapy. Third, if you don't decide to interrupt therapy, you do need to consider a genotype-guided change in therapy.

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