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Time For New Meds?
Dec 21, 2003

Tested Positive in March 2003. Believe I may have been infected for 5 yrs. but was never tested. 3-17-03 cd4 = 58 vl 198287 wbc 2.2; started meds of combivir and viracept 2 times a day; 7-2-03 cd4 = 200 vl 888 wbc 2.3; 11-17-03 cd4 = 196 vl 261 wbc 2.3. Based on what I read I would think my cd4 and wbc counts would be higher. Except for occassional diarrhea I seem to be tolerating these meds well. Of course with the wbc count and lower cd4 I am still tired alot but I feel much better than I did in March. Any suggestions ( med combinations) to get my cd4 and wbc count up? I have had two resistance test. I have asked my doctor for copies of the test results however, he has failed to provided those to me. He seems hesitant to change my meds. Suggestions?

PS - The Body has been a God send in helping me understand this disease. THANKS!

Response from Dr. Pierone

Hello and thanks for posting. Combivir and Viracept used to be one of the most common regimens for HIV treatment. The main weakness of this combination is for people with high viral loads (like yours). You have responded to therapy, but ideally the viral load should be less than 75 at this point. If the viral load continues to decline (I would check monthly to be sure) to undetectable then ok to continue. If it has reached a plateau or goes up you should consider changing to a more potent regimen. A more potent regimen would be either a boosted protease inhibitor (Norvir/Reyetaz, Norvir/Lexiva, and Kaletra) or a NNRTI (Sustiva, Viramune). However, is the level of virus does not go completely undetectable you may have developed resistance to Epivir, so the results of the resistance tests are necessary before any change is made.

The increase in CD4 count to 200 is about what one would expect. There is evidence that AZT seems to blunt some of the CD4 count recovery in response to therapy.

Good luck and give us an update on how things go. GP



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