Dec 26, 2002
I started treatment 12 weeks after infection. CD4 at time of testing 629 (23), though it had risen from 391(24). Now,after two years of treatment, 855(45). Was swictched from Sus/Combivir to Trizivir two months ago due to rising LD cholestorol. My doctor wants me to come off meds gradually (STI)
(1) Is my nadir 629 or 391?
(2) Would you feel comfortable about doing an STI with abacavir?
Response from Dr. Boyle
Your nadir is 391, but the significance of that nadir (which occurred during acute infection) is much less clear than that which occurs during chronic infection. I think it is reasonable for you to think about coming off medications, but the data supporting the benefits of or how to do an STI at this point are extremely limited. Also, if you are going to base the STI on viral load (i.e., you restart each time you exceed a certain level) I would be careful of using 3TC as that one point mutation drug may be easily picked off if this is done repeatedly. Finally, it is probably OK to use abacavir during the STI, so long as you have never had any evidence of the acute hypersensitivity reaction associated with that drug. There is, however, a very, very small chance that you may have that reaction despite a lack of symptoms, and therefore, to be very cautious, each restart should be done in your doctors office where quick medical attention can be provided should a problem occur.
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