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Sustiva/Combovir: first time user

Oct 17, 2002

I tested positive 2 months ago. My first labs show a VL of 192,000 and CD4 of 420. If my second labs don't show a significant decline of my VL, my doctor wants to start me on treatment: Sustiva and Combovir. I understand that side effects from these drugs most often fade in the course of the first month. What I'd like to know is this: if my VL drops below 50,000, is it possible to stop the therapy?

Response from Dr. Wohl


Most people don't think about it this way but in essence HIV therapy is a lot like birth control for HIV. The medications prevent the virus from reproducing. Take it and no new little HIV's running around. Stop it and its make way for HIV baby.

The goal of HIV therapy is to reduce the ability of the HIV in your body to replicate (make more of itself) to the lowest levels possible. When HIV replication is suppressed, the CD4 cell count increases, since virus is no longer killing these cells, and the immune system can function at levels that are closer to pre-HIV infection.

Ideally, the virus level should drop to levels below 50 copies/mL of blood plasma. This is the lowest level of the currently available HIV viral load test. Once the viral load is below 50 copies medication is needed to keep the virus suppressed. Once you stop HIV therapy, HIV makes more of itself and within days the viral load will shoot right back to 192,000.

In your case I would expect much more than a drop to 50,000 copies. You should get a viral load down to less than 400 copies and hopefully below 50. Once there, my motto would be if it ain't broke, don't fix it. Good luck - DW

Re: What do you think?
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