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I am also curious to know how long?
Jul 21, 2002

I was diagnosed with HIV in February 2000. My original regimen was Sustiva, Epivir, and Zerit. My viral load was somewhere between 60,000 and 150,000 (based on two tests taken two weeks apart)...and my Tcell count was about approx 550 in both. For the first 4 or 5 tests spread out over 1/2 to 3/4 of a year, my viral load was hovering in the 400-900 range, but wouldn't go to undetectable. My doctor suspected a possible resistance to the Epivir, so he added Ziagen to the regimen. Since then, I have been in and out of undetectable (some viral blips), but never above 500. I am over 99 compliant...which means to me that I take my pills twice a day within one hour of when I am suppossed to (95 of the time I take them within 1/2 hour or less). Several months ago, I had a stomach problem and had to come off my medicines for two days. Since then, no issues and my last test was again undetectable. From your research with a 4 combo like mine...is it possible I could be on the same regimen for many years to come, or does the fact that I wasn't able to get to undetectable on the initial 3 regimen indicate that failure will be sooner rather then later. My tcell count continues to hover between 800 and 1300. Thanks!

Response from Dr. Young

Thanks for the question.

Recent data about viral load blips (slight increases followed by undetectability) suggests that they do not sage early treatment failure. While the inability to achieve undetectability on your initial three-drug regimen could have caused low level drug resistance (probably to 3TC, but cannot rule out possible efavirenz), the fact that you have acheived undetectable viral loads now, likely means that the regimen is very potent. Indeed, efavirenz-based regimens have shown surprising long-term durability and tolerability.

So, overall, I'd have to expect long-term durability of your current regimen, particularly given your excellent adherence to this treatment. Indeed, an interesting, and unanswered question, is whether patient like you (who started therapy with relatively high CD4 cell counts) can safely discontinue therapy-- a study recently presented at the World AIDS Conference in Barcelona would suggest that this might be safe, so long as there was ongoing laboratory monitoring. -BY


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