In the past, I took AZT +3TC for two years but never achieved undetectable viral loads. Usually they were around 10,000. Then when the PI's came out, I changed to Norvir, Fortovase, Zerit, 3TC (continued), and Videx. Had a great response for 7 years with that combo, but recently viral load is creeping back up over 6 months yet is still <1,000. I'm thinking about asking to switch the entire combo rather than waiting for more resistance to build, and to eliminate the Videx/Zerit potential issues. Do I have any superbley aggressive and strong combinations I might want to consider?

You are running out of nuc choices, although the exact resistance pattern is not known and probably is not going to be found with a viral load <1000. (Genotypes require a greater quantity of virus for the test to work.) You've been on AZT, 3TC, DDI (Videx), and D4T (Zerit) so you are likely to harbor virus with multiple nucleoside resistance mutations. I believe you are wise to discontinue either the Zerit or the Videx (most no longer recommend these two in combination), but perhaps you could hold onto one of these and add another nucleoside (Ziagen or Viread perhaps).

Also, rather than waiting for more resistance to build, changing from the Fortavase/Norvir combo protease inhibitor to perhaps Kaletra (boosted Lopinavir) would be worth considering. On the other hand, you may want to try a non-nucleoside (Sustiva, Viramune, Rescriptor) with your nucleosides. If you have not been on a non-nuc, a med from this class could be very effective for you. You have not indicated what your t-cell level is, so be sure and review the options carefully with your doc.

Be well.