Is resistence less likely the longer on one combination?
Jul 21, 2002
Hi and thanks for answering this. I started my first regimen of Epivir, Ziagen and Sustiva two years ago. Original T Cell count was 32 and viral load was 60,000. Became undetectable with-in 2 months and T Cells are now around 285 and still undetectable. I would liketo have seen higher T Cells by now but am overall happy with results and well tolerating this regimen. Can I expect this regimen to contnue indefinitely? I recently read of a study of treatment naive patients who began treatment after the introduction of HAART meds and according to the findings it is conceivable to be undetectable for up to 20 years. This sounds too good to be true given all the data on treatment failures.
Response from Dr. Young
Thanks for your question.
Indefinately is a very long time, and I try to never talk about medicine in absolute terms. Nevertheless, the regimen of abacavir/3TC and efavirenz should be a very potent and very durable regimen, particularly in light of the fact that you've had a durable undetectable viral load. This later fact points to the absence of any significant drug resistance in your virus.
When one looks at treatment failures in persons with long-term successful therapy, there seems to be only a very small rate of treatment failure per year, after the first year or so. This can be seen in several long-term studies (looking at the "time-to-treatment failure" analyses)- as an example, we have a number of patients still on their original indinavir- or nelfinavir-based HAART, over 5-6 years since starting; seems like once they're past a couple of years, we really don't see appreciable treatment failure, just a want to adjust the regimen to account for new therapies or treatment simplification.
Good luck, -BY
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