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Follow up Q: results of VL test you recommended
Sep 21, 2003

Dr. Young,

Many thanks for your reply.

You mentioned that you had (have) a similar patient, who had a nondetectable VL without treatment, but bad symptoms. I hope you don't mind some final follow up Q's, but your answers would be very helpful for a discussion/planning with my doctor:

a. How long was your patient undetectable and what roughly were the VL and CD4 count when the VL finally showed?

b. What were the VL and CD4 count when you started HAART?

c. What HAART regimen did you use with him/her and did you start it when the VL was undetectable or did you wait till it became detectable?

d. If possible, can you please advise what symptoms he/she was experiencing with a non detectable or vanishingly low VL that HAART improved?

e. How is your patient doing now, symptoms wise and CD4, VL wise...

Sorry for so many Q's, but your answers are very important and could make a big difference in helping my doctor and me chart the right course in an unusual situation....and to finally start feeling well after all this time.

Thanks so much!

Response from Dr. Young

For this unusual patient, when the labs finally showed up, the viral load was very low-- only 400-500, CD4 count had declined to about 275. HAART was started primarily on the basis of the low CD4 count, though his symptoms (fatigue, night sweats and gradual weight loss) were pressing enough that I probably would have started anyways.

If I recall, the treatment regimen employed was efavirenz-based; either with Combivir or tenofovir/3TC.

His symptoms improved pretty quickly, with notable improvement in several weeks.

Of course, as you're aware, everyone's situation (especially cases like yours) are unique and deserve individualized attention.

Best wishes, BY


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