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3rd set of blood, 6th week on Videx, Epivir, Viread

Oct 28, 2002

Dr. Wohl,

Below was a prior question written to you late September. You might recall I have been newly diagnosed positive. My blood counts are below.

1st test September 6th - VL 674,888; TC4 603

2nd test September 10th and told I am positive - VL 750,000 +; TC4 same as above.

3rd test September 24th - VL 2,100; TC4 803.

4th test October 22nd - VL 422; TC4 657.

My regiment of medications consist of Viread 300mg, Videx 200mg and Epivir 150mg once each morning with a very light breakfast.

My doctor has told me we are shooting for a low set point. That point will hopefully be attained by my bodies own Virulogic response when the meds are stopped in about 11 months. One year from beginning the meds.

Given the above response, doseage and tolerance of the medication, is this an acceptable method of action?

Should I be inquiring about any additional blood counts or timing I am on this combination of antivirals?

Thanks in advance!!!! --------------------------- My prior question in late September

I was diagnosed HIV + on September 10th. The resulting test took place because I developed a fever which pulsed from normal to 101.9 over a four day period as well as complaining about aches and pains.

My doctor felt this was the initial infection and I was seroconverting. I had two sets of blood work drawn. The first had a viral load of 674,888, the second greater than 750,000. My Tcells were at 700. The second set was drawn on September 10, 2002.

I was given a choice to treat with meds or let my body take care of the infection until medication was needed. I was told of the growing "no med" philosophy in the medical field

I chose the meds thinking I have been newly infected and now is a good time to treat the virus. I was last tested in June. That test was negative.

Starting September 11th, I began my meds. It has been a little over two weeks and my latest result are quite dramatic from a number perspective - Tcells are now 803 (was 700) and my viral load has dropped to 2,000 (was 674,888).

My meds consist of Videx, Viread and Epivir. My next set of blood work is due in 4 weeks.

I guess my question is three fold.

1. I chose to begin meds thinking my infection is quite young and now is a good time to treat with antivirals. I just question whether this fever I encounted was my primary infection.

2. How quickly do Tcells start to drop in numbers after initally being infected?

3. Is this an unusally quick drop in viral load? Two weeks time.

Response from Dr. Wohl


Thanks for writing in again.

I think it would be safe to say that the treatment approach taken in your case is a tad unorthodox although it does seem to be working. For one thing, the combination you describe seems funky. Are you sure the Epivir (3TC) is really only 150 mg daily rather than 300 mg?

This is a combination for which there is very limited data during any stage of established HIV infection, let alone during acute HIV. The interaction between Viread (tenofovir) and Videx (ddI) is complex and the proper adjustment in the dosing of ddI when administered with Viread is not yet clear.

Given your high viral load off of medications, a protease inhibitor or non-nucleoside containing regimen would have been more conventional.

Are you sure you were experiencing acute HIV? Was your HIV antibody tests at the time of your treatment negative or indeterminate? I am suspicious. If you were actually HIV sero-positive (positive HIV antibody tests) I would probably have not treated you at this time - and certainly not with these particular drugs.

In all fairness, the combination seems to be working and if you did start treatment during early infection and are tolerating the meds I can see staying the course. Check on that dose of Epivir and stay tuned for more info on dosing of the ddI which we have been promised by the drug companies making these agents. - DW

Is my Treatment working?
Night sweats...

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