Aug 27, 2003
When a person starts therapy and it takes weeks for their load to go undetectable,isn't the virus replecating in the thousands even under drug pressure.Surely this is increasing the chance of resistance even with three drugs.Whats your view on induction/maintenance therapy for first timers. thanks
Response from Dr. Young
Point well taken, and there is the suggestion that in patients with very high (>100,000) viral loads, that the risk of premature treatment failure and drug resistance is higher. Your point was probably most pertinent to drug regimens in the past that were, let's say, less potent than the ones that we use currently.
Current efavirenz- or boosted protease-inhibitor based treatments have very little drop off in performance in persons with high viral loads.
Nevertheless, some doctors do start persons with extrememly high viral loads on four drug regimens, perhaps with the the later goal of reducing to three drugs (i.e., induction-maintenence). I think that this is a viable option for selected patients who can tolerate the additional medication and/or pills; though this strategy (4- to 3-drug induction/maintenence) has not been well studied. Until such time that we have good clinical data on this strategy, I would recommend that it be done in the context of clinical studies or in the hands of experienced HIV clinicians. BY
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