Hi Dr. Boyle, I found out I was HIV+ in 1997. I think I was infected in 1989. I started on a three drug combo (Viracept/Epivir/Zerit) in 97 which worked very well and kept my viral load undetectible for years. My doctor switched my meds in November 2002 due to the side effects - neuropathy, lipoatrophy, cholesterol, etc. He put me on Trizivir alone. My viral load started blipping - the highest was 700. It finally settled down to 386 last month, but my Dr. decided to add Viramune to the Trizivir. I just got my labs back after one month of the new combo and my viral load only went down to 253. My dr. said he was surprised that it didn't bring me down to undetectible. I've only been on Viramune for a month - is it too soon to rule it out or do you think it's not working?

Thanks for your help! Alex

Your medications are "working", but not as well as they should. It is likely that you have Epivir resistance at this point and that may, in part, explain the underperformance of the regimen and the viral breakthrough when you were only on Trizivir. If you're tolerating the current regimen well you could continue on it and monitor you're viral load carefully, with a plan to change if you go back over 400 copies/mL, however, this risks the development of more resistance. Alternatives are (1) if you are <400 copies/mL, to once again intensify this regimen (for example, with Viread) or (2) to change to another regimen. I would favor 1 if you stay between 50-400 and 2 if you go back above 400.