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update for Dr.Wohl
Nov 1, 2002

Hi Dr.Wohl, I thought I should sent along an update.I was "the freaked" party on sti.I just had my labs run and everything is quite okay for the moment.My cd4 count did drop the "average" amount reported in studies but I still am above 700 so I have a safety buffer there.My vl, rose, but suprisedly to all( me especially) instead of zooming back to baseline (which was in excess of 100,000) it came in at in the 10k range.Now obviously I elected to continue on the sti as it is SO NICE to be drug free for a while,and I do feel so much better from a physical standpoint.My doctor and I do have a very good relationship and he agreed there was no point to reinitiate drugs at this time.Now we are going to just monitor closely and have discussed restarts but untill that criteria is actually met, it's just basically lab to lab.I have a few questions?If I were to go all the way back to baseline> 100,000.When would that normally occur? Also is there a chance I will just slowly increase in the vl area the same as a treatment naive person or is that not possible? Finally, since I am different from a treatment naive person are the rules different in respect to if I have a "bad lab" should I automatically be thinking meds again or is it the case to repeat and follow as you normally would with a non treated person.I realize this is alot of uncharted territory, but if there is any way to coexist with hiv and not have to be on meds for a continous lifetime, that is my goal.Thank you

Response from Dr. Wohl

I am really glad things are working out. Your results are actually not that unusual. A group from Washington University in St. Louis has just published a report on their experience with stopping HIV meds among patients with viral loads below 500 copies/mL and either side effects or who by virtue of their CD4 and viral load opted for a break (Pablo Tebas, et al- Journal of Infectious Diseases, Sept 15, 2002).

Overall, during the year or so of follow-up people did well and for half the virus rebounded to a steady level BELOW their pre-HIV therapy baseline. Importantly though, the major predictor of CD4 decline off therapy was the rate of CD4 increase the patient had experienced way back when they started on their HIV medications. Those who had a robust CD4 increase on meds were more likely to have a slow drop in their counts off of therapy. Of the 72 patients studied, 4 did get opportunistic conditions off HAART. All of these patients had counts that dropped to less than 200.

It is not clear what will happen with your viral load but as long as your Ts stay plentiful, I wouldn't sweat the viral load too much. As in almost all cases, a worrisome lab should be rechecked. If I were you, I would hang in there and work my plan. No freaking out allowed. DW



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