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HAART for symptomatic patients with undetectable VL
Jun 27, 2003

If treatment is recommended for highly symptomatic HIV positive patients, even with undetectable VL's and normal CD4 counts, how do you know what drugs to use(in the absence of enough virus on which to do resistance testing)? Do the symptoms help you decide which drugs to use in this situation?

Thank you.

Response from Dr. Young

Thanks for your question.

This is a difficult one to answer with details, but I'll try to answer with pure opinion (I actually have a couple of patients in this very situation).

For symptomatic patients with normal CD4s and undetectable viral loads, the first thing to do is to make sure that nothing else is causing the symptoms.

Assuming this, then yes, it is not possible to obtain resistance testing for these person's virus-- as such, I would rely on any information about the source of infection (contact person or city of infection) to guide the question of the likelihood of resistance. Symptoms, in and of themselves are not sufficient to guide therapy.

So, in the end, we do our best to pick medications, and follow response (here, by CD4 counts only) closely.

Good luck. BY



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