This is in response to the Sept 5th post regarding the drop in Tcell with Videx and Viread. FOr 4 years, I had a tcell count above 1000 on Sustiva, Zerit, Epivir and Ziagen with an undectable viral load. Due to my fears about Zerit, my doctor switched me to Videx EC250MG, Viread, and Emtriva. I started experiencing kidney abnormalities (high protein, high creatine) and my tcell slowly dropped below 500 while remaining undectable. We stopped the Videx and maintained a Viread, Emtriva, and Sustiva regimen. Tcell continue to drop with same kidney abnormalities and undetectable viral load. Just recently switched to Norvir, Emtriva, Ziagen, and Reyataz. My first test showed an increase in my Tcell to 492 (first increase in a year) and still undetectable. Kidney abnormalities have disappeared. I feel great and I am very optimistic that my next test will show greater improvement (especially since the last test was taken 5 days after a 2 week cold). Anyway, my point is that it was the Viread most likely causing me the problem all along..not necessarily the Videx.

I don't mean to say that it is wrong to use Videx and Viread together, but these preliminary data showing CD4 count declines in some patients on this combination are worrisome. In addition, there have been recent reports linking the combination of Videx EC and Viread to higher rates of kidney toxicity than Viread alone. This may be relevant to your situation since it sounds like the CD4 count decline and kidney toxicity began after the switch from Zerit to Videx.

I realize that the kidney issues continued after the Videx was stopped, but sometimes there is a delay in offset of medication-related side effects. The other possibility is that the kidney issues and CD4 count drop were just related to Viread, but the onset after the Zerit to Videx switch seems more than a coincidence.

A larger issue has to do with the commonplace practice of using 4 drug regimens for management of HIV infection. Multiple studies have shown no additional benefit of quadruple therapy over a standard triple regimen. It seems that the additional potency of the 4th agent does not overcome the higher rate of adverse events and result is a wash. But the pharmaceutical industry does not lack for persistence (with the proper incentive), so we should expect to see more studies aimed at proving the superiority of quadruple over triple therapy.

Ok, off my soapbox and back to your situation. Your current regimen is an excellent one and I would expect that you will see a rising CD4 cell trend over time. Thanks for posting.