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vl going in wrowng direction
Aug 14, 2002

Dear Doc.you have answered many questions for me in the past hope you can help me now.let me give you my background.tested poz in nov 2001 had labs done in dec 2001 initial vl was 704.000 cd4's 240 started suctiva and combivir jan 14th 2002 march 1st vl 950 cd4's 540 may 1st vl 535 cd4's 620 now aug 1st vl 1500 cd4's 840 im verry happy with the cd4 increase but what is going on with the vl shouldnt i be undectable by now and why would it go down to 535 now up to 1500 is this the start of drug resistance? i have never missed a dose not one. was late takeing them once by 4 hours have gotten drunk a few times thats all could this be why?also i was never tested for drug resistance before starting meds.my doc says not to worry we will retest in nov but i cant help but worry after doing so well for 8 months and now vl going back up.your thoughts and comments would be greatly appraciated.thanks

Response from Dr. Young

Thanks for your question.

Would definately seem like you've had a nice immunologic response to therapy.

I do share your concern about the persistent viral load. This would suggest to me that you have some degree of viral resistance, and as such, deserve some additional diagnostic and/or therapeutic thought. I'll assume that in addition to having excellent adherence, that you havent had a recent infection (including herpes) or vaccination-- as these can raise your viral load if they occur around the time of the lab testing.

It might be possible, that you were infected with a resistant virus- this would explain the lack of undetectability despite excellent adherence. Either way, with a viral load over 1000, it should be easy to obtain an HIV genotype (or phenotype) to figure out what is going on. Typically, if caught early, treatments can be modified (either switch out of the resistant drug or intensification with a 4th drug).

I don't think that in this setting that it's appropriate to simply wait an additional 3 months to reassess. Keeping you on the current therapy without evaluation places you at risk of increasing levels of resistance and (worse yet) cross resistance. I'd recommend a reevaluation probably no more than one month after the current set of tests, if not sooner.

Let us know how you do, good luck. -BY



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