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wasting future options
May 30, 2002

I am on what I think is a pretty potent reg. It is viramune,viread and viracept. I ended up with these three because I've tried many drugs in the past and changed because of side effects. My numbers are excellent undetectable and high cd4's(950). I'm thinking I should be saving either the pi or nnrti for later(can't take sustiva because of bad mental reactions)I do have 3tc resistance from several years ago,so that rules out an all nuke regimen.I know it is never reccommended,but maybe I should only be on two drugs.I've tried this for a short time(again a side effect)and it helps some and my load stayed undetectable with a higher cd4. I only did it for a month (followed doctor's orders)so I wouldn't mess up anything. Yet I read so many people living well with cd4s in the lower range(350-500)I just wish I knew what would happen if I stopped for awhile. I do know I would feel "normal" again.Now since I've recently started viread I definately don't want to lose it,but I wish I'd saved it,because I don't have ziagen(reaction,probably a false alarm,but my panicing forced a stop and that's the end of that one)so in nukes I'm only left with high toxcities and if low toxcities make me feel like crap and do things to my body,the high toxcities will probably really mess me up long term. How high can a viral load rebound before you are in danger?(If you decided to interupt treatment?)Would you be able to regain all your cd4's if you slipped from 1000 to say 400? Is the any difference in viralogical response for someone diagnosed and treatment naive(chronically infected)vs someone pretreated with an awesome response,but needs abreak?

Response from Dr. Boyle

This is an area that is being researched and we don't have definite answers. Based on current studies, we know that regardless of current CD4 count, patients who interrupt HAART tend to return relatively rapidly to their nadir (lowest) CD4 count. Therefore, so long as your T cells have never been very low, say less than 200, it would not be unreasonable to interrupt therapy and monitor you carefully for changes in CD4 count. I would not pay that much attention to the viral load since it may go quite high during the interruption before settling back down to your set point. While you may need to restart therapy at some point, you may be able (as some of my patients have) to be off therapy for some time. Switching to dual therapy is NOT a good idea - that strategy has been tried in several studies and failed. Finally, it is possible to regain CD4 cells when therapy is restarted and viral load is once again controlled.



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