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Average time to undetectable when starting treatment
Nov 24, 2003

Hi doc,

I've been on treatment for 2+ months (FTC, Viread, Boosted Reyataz). My pretreatment VL was 40k. After 1 month on treatment, my VL dropped to 440. After 2+ months my VL is now 146. Also, my lymph nodes are still swollen, although less pronounced than when I was infected in July. I'm very nervous that my VL has not dropped to below 50, even after 2+ months of treatment and that my LN are still swollen. Are my lab results and swollen LN reasonable or would you consider an alt. treatment. I've spoken to my doc but he seems unconcerned. My primary concern is that since Viread lowers Reyataz, my drug levels may not be high enough to completely shut-down HIV replication and prevent resistance (especially in my LN). What would you recommend a patient do in this scenario.

BTW- My CD4 counts went from 297 to 587, so I'm happy about that.

Thanks

CD

Response from Dr. Wohl

Dear CD,

I understand your concern. The good news is you have had a great result both virologically and immunologically. I think I would wait another month or so before getting too concerned about your persistent but low level viral load. Even if on recheck it is still around 100, I may not be all that worried. Some people believe this may be virus being released from latently infected cells and that this virus is not resistant to HIV drugs. If the viral load is much higher, then suboptimal suppression is a possibility. In that case, I would order a genotype to try to see if enough virus is present to look for resistance.

Drug levels can sometimes also be checked and if possible, you could ask if an atazanavir level could be obtained. DW



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