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How long can regimen last--follow up
Feb 28, 2000

Dear CC:

On October 12, you answered a question about how long successful therapy can last from a person who is nearly 100% compliant. In your answer, you mentioned a study in which a similar population remained undetectable for the duration of the study. However, you didn't mention how long the study lasted. How long can people who are undetectable and fully compliant expect to last on their initial therapy? Is there any data on this? What's the longest? What's the average.

Thanks.

Response from Dr. Cohen

Well, I don't recall exactly which study I mentioned in October - but the punchline is - there are studies that show that those with the lowest viral loads can maintain suppression for as long as we are following them - which in the longest report studies is beyond three years. And there is little reason to suspect that this all collapses in year four unexpectedly. What it comes down to is that for those who are able to find a combo that they can live on, that they can take each day, that the body gets ample blood levels of the meds, that there are no prohibitive side effects in the way - that this stalemate in controlling HIV might last indefinitely. For example, Sustiva just was given full approval by the US FDA because a study of it in combination with Combivir showed that for those with a viral load below 400 copies - the viral load stayed suppressed in 90% for the next two years. And my hunch, for what it's worth, is that if we look at those who have a viral load well below 50 copies, and look at those who stick with the meds each day - that 90% success rate could be even a bit more. Not perfect of course - not much is. But close.

Hope that helps.

CC



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