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Dec 20, 2002

Dr Yound,this is a bit of an update and to ask whats going on with me.iv'e written you sevral times over the past year asking questions and giveing updates so here goes again.i was diagnosed last nov with a vl of 704,000 and cd4's 240 27 i started on sustiva and combivir jan 14th 2001.results as follows march 1st vl 950 cd4's 540 may 1st vl 535 cd4's 620 aug 1st vl 1500 cd4's 820 nov 1st vl 3000 cd4's 914 also did a geno test for resistance on nov 1st came back neg im not resistant to the meds im on now or any the past year i have missed 4 doeses of combivir and have not missed any doc says sence im not resistant to stay on my meds till we test again in feb question is why is my vl going up? my tcells are going up also wich im happy about but i dont understand the viral load.can you give me your thoughts please. thank you

Response from Dr. Young

Thanks for your question.

Your situation is not a rare one-- we do have a small number of patients with persistent, low level viral loads, without obvious evidence of drug resistance.

The key point in your lab data is that you started therapy with a very high initial viral load (700,000). As a result, the time to reach undetectable levels can be prolonged, even though you've had a dramatic reduction in the amount of circulating virus (more than 99%). The fact that the CD4 cell counts continues to rise is also consistent with the lack of significant drug resistance or treatment failure.

So long as you feel well, and you're able to stay with the medication regimen with excellent adherence, I'd continue to monitor things closely. Let us know how things go. Good luck. -BY

Viral load drop with Combivir/Sustiva
Post-exposure prophylaxis

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