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re:Undetectable, now what do I do?

Aug 18, 2004

My viral load was greater than 1 million and my CD4 was 279 at it's nadir. After six months Kaletra, viread and epivir cd4 are 561 and VL is 70, which in theory would be undetectable or less than 50 copies. I also drank 15g ZiCao (shikonin) every for the first 3 months because it is purported to downregulate ccr5 receptors on cell surface in culture at nanomolar concentrations. At about 30% W/W shikonin this should provide a good plasma concentration if it is absorbed. If not it was my hope it would provide protection to GALT (gut associated lymphotrophic T cells) which apparently suffer the greatest decimation during acute infection and are the last cell subset to recover post ART, as compared to PBMC. I have stopped using the tea everyday because it is a hassle to make and I feel better. I do still feel symptoms in the lymph nodes and imagine it is a combination of immune reconstitution. I conceptually would prefer an entry inhibitor or immunomodulator such as ZiCao in a more convenient form, rather than a PI. Sorry to be so long winded but I spend alot of time researching and I don't get to bounce my thoughts off anyone. Thanks JGP

Response from Dr. Pierone

I can't comment on the use of ZiCao due to the paucity of clinical data. The new entry inhibitors are making some progress in the pipeline, but realistically are years in future.

The regimen appears to be working and it seems reasonable to continue it unless you are experiencing any side effects. There has been a trend towards using more lipid-friendly cocktails, fewer pills, and once daily therapy for HIV infection. Nonetheless, Kaletra remains quite popular and many patients tolerate it quite well. One of the strengths of Kaletra-based therapy is the high potency and this may be important when the initial viral load is very high (although NNRTI-based therapy also performs well in this situation). If you have significant side effects, consider switching, otherwise it seems prudent to carry on with the current regimen.

Best of luck and thanks for posting.

Taking 1 drug now, another later in the day, then rescheduling...
Doctors and drugs

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