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recently diagnosed with AIDS

Mar 12, 2002

My brother was recently diagnosed with AIDS.He had a transfusion in 1987 and was notified in 1988 that the person who had donated the blood products had died of AIDS. All of the tests he had taken over the years had been negative until 12/01. His CD4+ count is 69 and his viral load is 626,712. For the past 18 months he has had several conditions including CMV (which caused heart damage), on-going oral and esophageal thrush, dramatic weight loss (250 to 160 @ 6'5"), fatique, pain, and fevers. The meds he has been prescribed are: Combivir,diflucan,nevirapine, azithromycin, and atovaquone. My question is should I ask his doctors about the possibility of him taking a protease inhibitor? Is there any other drug therapies I should look into for him?

Response from Dr. Young

From the sounds of things, your brother very likely has acquired drug resistant virus (assuming that he is taking his medications). The fact that he has symtpomatic disease and very low CD4 count would certainly prompt a therapeutic reassessment.

In these circumstances, I'd want to know what his current CD4 and viral load are, as well as determining a HIV drug susceptibility test (genotype or phenotype). The later can definately assist with further drug selection. Typically, after failure of Combivir/nevirapine, one can expect resistance to 3TC and probably to nevirapine. Such virus typically retains full susceptibility to a number of nucleosides and protease inhibitors.

I'd definately recommend a prompt evaluation, and after careful thought, initiation of his second regimen.

Good luck. BY

The question: meds or no meds?

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