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Is my drug combination appropriate?
May 31, 2002

Dr. Cohen, I am concerned about the drug regimen I am on. I tested positive in 1986. Started on meds in September 2001. Combivir and Videx EC. At that point my cd4 count had fallen big time to 140, and my viral load had skyrocketed to 310,000. After 30 days on my meds,my viral load was undetectable under 400. Now as of April, my cd4 was 208, and my viral load was undetectable under 50. My original doctor who started me on my meds had moved in January. What I am wondering doctor, is if my drug regimen is appropriate to suppress the virus on a long term basis and are they ok together? Seems to be working ok so far. But visiting your website, I have not seen anyone else on this combination. Also, I contacted the NIH about maybe taking part in a drug interruption study, but the nurse that I talked to said I qualified in every aspect, except the drug regimen I am taking, is not acceptable to be on the study. This has got me quite concerned doctor, about my meds now. But if they are working I hate to change them. I really could use your help and advice Dr.Cohen on what to do, since I have not yet found another hiv doctor to go to right now. Especially if this drug combination I am on, is not appropriate for some reason that I am not aware of. Also thanks Dr. Cohen for all your other help on other questions. Randy

Response from Dr. Cohen

Hey Randy.

It is fair to say that there have not been too many studies of the combination you are on. I recall that several years ago, however, there may have been one study that used this combo - and the results were just OK but not at good as other choices we have - so this combo was not pursued further. So it is a bit surprising that someone would select this combo of all of the current choices to start on in the past year. But since it worked for you, as it has so far, then there is nothing intrinsically wrong with it for you. Getting to <50 on whatever combo, as you have, should work well enough in terms of prolonged suppression. However, since your combination is not familiar or standard, there may be some situations or research studies, such as the study you mention, that would want you to be on an alternative combo of something more studied and proven in order to proceed. But other studies may not have this same restriction... so that part is variable.

Nonetheless, it is a bit fortunate that your particular combo is working so well for you - especially with your initially high viral load and lower CD4 count - with these types of numbers you had at baseline - a viral load over 100,000 - combinations of three nucleosides generally have a lower success rate than other combinations we often use instead. But sometimes they do work for some people - and again, it appears that you are in the luckier group. So it is OK to stay... until you connect with a new clinician and review your options. It may be fine to leave it be - or to make a switch to something more researched. It may be for example, that a change to a more potent combo could further increase your CD4 counts faster. Or be more durable and avoid "blips". But there is no rush to change given your outcomes. So you have time to locate a new clinician.

Hope that helps.



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