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The right precription?
Apr 21, 2003

Hi Dr. Young. I am a 31 yr old female in Southern CA recently diagnosed as being HIV+. My CD4 212. Viral Load??(somehow the lab missed this test so i had to take it after my recent doctor's visit). He prescribed Trizivir as a stand alone treatment. I have no symptoms (thank God). My question is... was it right for my doctor to prescribe Trizivir without knowing my viral load??? hmmm(given the recent study concerning Tivizir's efficacy) and will it in the long run, do more harm than good?? I'm a little nervous about that and my Doctor's competence.


Response from Dr. Young

I would tend to agree with you in wanting to know your viral load prior to starting on Trizivir stand-alone treatment. Previous and recent (ACTG 5095) data suggest that the regimen might underperform, relative to other two-class regimens in persons with higher viral loads (greater than 100,000 copies), hence knowledge of your viral load might cause you or your doctor to re-think your drug options.

In my practice, Trizivir stand alone therapy is typically reserved for persons who really desire a low pill count regimen and want to avoid the use of either non-nucleosides and protease inhibitors-- this statement is based on the wealth of data from simple, low pill count regimens based on two nucleosides with efavirenz (or nevirapine). Indeed, for persons with the highest viral loads, we've used Trizivir with efavirenz or Trizivir with Kaletra with very good results.

Now that you've got the script, an alternative approach would be to monitor your viral load responses very closely-- there is at least anecdotal evidence to support early treatment intensification (with a NNRTI or PI) for persons who do not achieve undetectable viral loads after the first several months on Trizivir-alone therapy.

Good luck, and let us know who things turn out. BY

Another Q for DR. Wohl

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