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Husband HIV+and WifeHIV- IV
May 11, 2003

Dear Dr. Benjamim,

On Dec 20, 2002 I told you: "on the next letter I will talk about my situation." The last sex relation with my husband without condom was on July 31, 2002. I told you I did the ELISA, WESTERN BLOT and PCR tests on September 9, 2002 and the first results were negative. I promise, I will repeat ELISA test this month , and I will confirm to you the good news!!! Is it OK for you? As I said, I am keeping in touch!! Let's talk about my husband again. God bless you! My husband wrote for you on Aug 24,2002 and I wrote the others letters on Aug 28 and Dec 20,2002. My husband started the treatment on Oct 1th,2002. The adhearence remains 100 and he takes all the meds on time. The therapy is 3TC(300 mg) +AZT (150 mg)/ two times per day - 10:00 AM and 10:00 P.M.; and EFV Efavirenz (3 X 200 mg) at 10:00 P.M.. I will show the evolution the laboratory monitoring: On Apr 02, 2003/On Dec12,2002/On Sept 17,2002: the results are: RED BLOOD CELLS RBC 3,94/4,31/5,03 , Hemoglobin 15,4/14,0/14,9 , Hematocrit 42,9/42,4/44,7, Average Vol.Glob 108,9/98,4/88,9 fl, Average Hem. Glob. 39,1/32,5/29,6 pg, Average C.H. Glob. 35,9/33,0/29,6 g/dL, RDW -CV 12,4/22,9/12,8 WHITE BLOOD CELLS WBCleukocytes 3800/3300/4400 , basophils 0/0/0, eosinophils 38/33/44, lymphocytes 1368-36/1287-39/1100-25, T4 (CD3+/CD4+): 328-24/347-27/264-24, T8(CD3+/CD8+): 889-65/837-65/726-66, lymphocytes B (CD19+):68-5/ 51-4,4/44-4, relation (CD4+/CD8+): 0,37/0,41/0,36 , monocytes: 304-8/264-8/176-4 Platelets count: 226/207/213 Total Cholesterol: 199/233/193, Triglicerides:165/130/120, blood sugar: 93/94/101 , VL: (Ultra-sensible bdna) 84 copies/ml-1,92log/ (PCR) undetected/(PCR)24300 copies/ml 4,38log.

1)Please comment in details the results and the side effects; 2) Which are the next steps? Concerned, take attention, modify therapy perscription or not,..... 3) Would you please tell us about the evoluation. My husband has 39 years old and remains in a good shape and his health and quality of life doesn't change. I will say again: thank you so much, you are a good angel. Again: On the next letter I will talk about my situation. I will keep in touch. Doctor Benjamin I love details, ok!!?

Response from Dr. Young

Thank you for your question.

I apologize for the delay in my response.

It is very good to hear about your antibody testing.

It would appear that your husband has had a good initial response to combination therapy with ZDV/3TC/efavirenz. His current viral load is very, very low and not reason to be of any concern at the moment. CD4 cell count increases usually lag behind the dramatic improvements in viral load--if we look at his CD4 percentages, they are very good, and while not normal, the CD4/CD8 ratio are also very good.

The other labs are also within acceptable limits, notably normal cholesterol and triglycerides. You've not mentioned if your husband is having side effects at this point, but usually on this drug regimen, they are mild and not the cause of treatment changes. Occasionally some persons have difficulty with either the ZDV (headaches, nausea) or the efavirenz (sleep disturbances, moodiness), but again, these rarely result in the need to change the treatment.

Next steps are to continue with the vigilence on adherence and side effects; make sure that all of the other health issues, like vaccinations, diet, exercise are up to date. I'd probably not make any recommendations in changing this apparently sucessful treatment, particularly in light of several recent clinical studies which would seem to place ZDV/3TC/efavirenz as one of the most prefered treatment combinations.

Good luck; we look forward to hearing about how things go for you and your husband. -BY



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