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Drug Holiday
Nov 16, 2004

Hello Doctors,

I have 2 questions: 1- My uncle has been HIV+ for about 12 years. He has been off medicine since March 03 (Tcell 1100, undetectable). In Nov 04 his Tcells were 250 and vl of 31000. His doctor recommends that he should not take the flu vaccine because it would reduce his Tcells. Is this wise? 2- Before going on a drug holiday, he had resistance to many Haart medications. In Nov 04, his doctor did another resistance test. Now he is NOT resistant to ANY medications. Is this possible?

thanks for all your support. Kar

Response from Dr. Young

Kar- Thank you for your questions-- it's good to hear that your concerned about your uncle's health. Patients who have families who are involved with their care typcially fare better than those patients who cannot tell their families about their health issues.

Now, to your questions.

I'd disagree with your uncle's physician-- while a flu shot might transiently change his CD4 count, these changes are almost always without significant consequence, and the CD4 will return to baseline in a matter of a few days or a week. Influenza is a very serious, sometimes fatal disease that is, to a large extent, vaccine preventable. Influenza vaccinations are highly recommended by many treatment guidelines from across the world and would be considered medical standard of care (assuming that one could obtain one in this year's shortage).

As for the resistance test, it is not unusual at all to see a patient's viral drug resistance test to shift from resistant (while on medications) to drug susceptible (while off medications). The reason for this is that in both circumstances, there is a large body of archived virus that can be selected in the blood depending on the presence or absence of drug pressure. This is a classical example of Darwinian evolution, or the survival of the fittest. When you're uncle was taking HIV medications, only those viruses that were able to grow in the presence of the drugs (i.e, drug resistant virus) were detected. Because these viruses are usually less fit than non-resistant virus, so when your uncles drugs were stopped, the non-resistant viruses grew again and became the dominant population of circulating virus.

Hope this helps, thanks for reading. BY



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