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Desperately Seeking Undetectable
Apr 9, 2004

Hi, Docs. Thanks for your answers in the past...

Here's the Readers Digest on my sitch: last tested neg in June of 2003, diagnosed poz 11/14/03, started treatment 1/1/04, genotype & virtual phenotype showed no drug resistance. Stats to date are...

DATE CD4# CD4% VL ____________________________________ 11/18 367 21 255,000 12/11 305 24 214,000 12/30 193 21 876,000 1/6 248 25 68,900 1/13 232 24 7,310 1/27 247 25 2,270 2/24 238 27 1,040 3/30 261 26 (not back yet)

As you can tell from the frequency of my testing, I'm part of a clinical study. At my last visit, my doc told me that they now think I contracted "a particularly virulent strain" that accounts for the fact that my immune system took an "unusually hard hit" in the first six months of infection.

From a VL perspective, I think my regimen (Sustiva-Epivir-Viread) has had a great response in a relatively short time. And I've never missed a single dose. But I'm still anxious to reach undetectable, which they tell me may still be several months off. Also, I'm concerned that my T-cells aren't bouncing back very robustly, and that this might not bode well for my long-term prognosis.

Your take on this would be appreciated.

Best, D

Response from Dr. Wohl

Dear D,

You certainly have had a dramatic response to therapy with a drop in your viral to a hundredth of what it was and actually a pretty decent increase in CD4 by absolute count and CD4%. Clearly, you would like to be undetectable (less than 50).

You are on a potent regimen and you report excellent adherence. Therefore, I would try to look at a few things. First, I suggest that a genotype be done now if your 3/30 viral load is still around 1000. Just because you had no resistance seen at baseline does not mean none was present in low numbers. Second, I'd make sure there are no interactions with other drugs, herbal products, grapefruit juice, whatever, that could lower drug levels. Similarly, any diarrhea could impact levels of the meds.

It is probable, your 3/30 viral load will be less than 1000 and that you will get to or very close to undetectable. IF that is the case, I'd just keep monitoring on your current therapy.

DW



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