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Viral Loads - Length of Time to Drug Failure

Feb 27, 2002

I am an MT (Med Tech) who discovered that his partner was HIV+ via Rapid HIV testing that confirmed by Western Blot. He tested negative 5 months prior to the positive test that I did out of concern for his symptoms at that time (fatigue, malaise, chronic sore throat) Initial Viral Load was 75,000, CD4 197. I also suspicion he had an EBV infection at the intial diagnosis time, since, I had one that took me 2 months to recover from! Today, two years later, he takes Combivir 2/day and Sustiva, viral load was <50 copies after initial testing and has remained there since then...CD4 count seems to hold steadily in 400-500. He was diagnosed at age 18 and is now 20, and is asymptomatic. How long is a person statistically able to remain on a drug regimen before it is necessary to move towards more complex ones?....and what is the prognosis for someone of his age and laboratory values. He religiously takes his meds on time.

Response from Dr. Young

Provided that one is able to tolerate the medications and is able to figure out the difficulties with adherence; I think that the durability of treatment regimens can be very, very good. We have several patients in our practice who have been on their first HAART regimens for over 5-6 years; the fact that your partner achieved an undetectable viral load early and has maintained undetectable levels is a good prognostic factor. How long all this will last is really anyone's guess, since we have only had potent regimens since 1996 or so. Clearly this goal has not been achieved by everyone; there is much to learn about how to increase the odds in a favorable way, to increase the likelihood of success after first- and subsequent rounds of therapy.

It is my hope that between treatment potency, immune therapies and (ultimately) intelligent treatment interruptions (whether this is STIs, holidays, cyclic therapy remains to be seen), that we can realistically think about decades of disease free survival. BY

CD4 and viral load tests
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