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worried about resistance

Jun 21, 2003

dec 11,02 i started treatment for aids with viread,viramune,and epivir along with zithromax,bactrum,zovirax,diflucan, and xanax at the time my cd4 count was -20 and my viral load was 450000 i was also hospitalized for pcp before i knew i was hiv poz in february my blood work read 39 count cd4 and my viral load was 38000 and i felt very happy but recently in april my new bloodwork read 26 cd4 and viral load of 56000. my doc has for now added kaletra until we find out what has stopped working i am very concerned. i am also taking oxadrin,welbutrin, and androgel. in the begining i lost about 30 pounds but have since gained it all back plus 5 extra and have maintained it for the last four months. is it normal for someone like me at less than six months into treatment to have already have developed resistance. i have not missed one dose. i also want to know am i taking too much medication, i trust my docs but i am concerned about the amount of chemicals in my body. so any help or comments will be greatly appreciated. thanks, worried about resistance

Response from Dr. Pierone

Hello, it sounds like you have been through a tough time; glad to hear that you have gained you weight back. You didnt mention if you are tolerating the medications so far, I assume that you are not having significant side effects.

Since your pre-treatment viral load was 450,000 and at 3 months was 38,000, and at 5 months was 56,000 this does suggest that you may have developed early resistance. It sounds like a resistance test is pending and you should have an answer soon. People with low CD4 cells and high viral loads seem to be more likely to develop virologic resistance, although not all studies agree on this point.

Some people with early viral break though on treatment develop this because they originally had drug resistant virus transmitted to them. The only way to know this is if you had a resistance test done prior to starting therapy. Resistance testing at the time of diagnosis of HIV is not routinely done, but in the future may become part of standard care. Especially in regions in which there is there has been documented transmission of drug resistant virus.

The regimen you were started is a very good one streamlined, potent and well tolerated. But one of the weaknesses of a regimen like this is that there is a relatively low barrier to development of resistance. It just takes one mutation to develop resistance to Viramune, and the same for Epivir. Your doctor added Kaletra while waiting for resistance testing and will likely adjust the regimen once the results are in. Kaletra is very potent and since you are fully adherent it is likely the viral load will come under control. You may be on less medication once your results are in; also you may be able to get off oxandrin and androgel in the future depending on your muscle mass and testosterone levels.

Let us know when you get you resistance test and follow on labs with the new regimen. Good luck!

Drug therapy for HIV infected 18 month old?

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