Intensify With No Viral Load?
Mar 29, 2002
I have been on AZT, AZT/DDC, AZT/DDI/3TC and D4T/3TC/NFV regimens with some treatment failure because of adding one drug at a time or inadvertently taking a substandard dose. For example, I had as high as 2500 VL on D4T/3TC/NFV because I mistakenly took 1 pill three times a day instead of 3 pills three times a day. I haven't taken AZT, 3TC and DDC since years ago before viral load tests were available (I was in the first AZT study); and I am assuming I failed treatment based of a slide in T4 from the upper 40s to the upper 30s at the time. I switched from the NFV regimen to a SQV/RTV regimin for just one year with complete surpression (no detectable viral load); and then switched two years ago to EFV/DDI/D4T to avoid side effects from the protease inhibitors. While I have remained <50 copies with only an occassional blip to 300 copies or so viral load on this combo during the past two years, I am very concerned that the EFV is the only really new drug in this regimen and that one day it may fail and I will lose the NNRTI options (just one mutation away!). I probably already have limited NRTI options based on prior history. I have some, but only mild lipodostrophy and T4 cells are almost always between 750 and 1200 (35-38). I rarely miss a dose although I may be a four or five hours late sometimes.
So, do you think I should modify or intensify this combo now to save my NNRTI options or to make sure it lasts several years, or do you think I may have enough options remaining if the EFV begins to fail? Thanks for your thoughts...
Response from Dr. Boyle
Given your current success and a viral load <50, I would not intensify the regimen at this time. I would keep a careful eye on your viral load, however, and consider intensification if you had a breakthrough. It is very important that you take your medications very carefully and religiously since this is likely to continue their effectiveness.
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