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stopping/restarting first round treatment
Jan 14, 2005

I am a 36 y/o male who was diagnosed HIV+ 8.5 years ago. When I was diagnosed, the treatment plans were much different than today, in that drugs were given to patients as soon as they were diagnosed. I was started on Fortovase 1600mg BID, Videx chewable 200mg BID and epivir 150mg BID(this was an experimental dosing schedule from a clinical trial). This medication regimen worked well for me, and I really had no side effects, so I was left on it even after the clinical trial stopped due to it being an overall failure for most patients enrolled. My CD4 count remained in the high 800's and my viral load was undetectable.

Due to a loss of my job and insurance, plus a waiting list to get onto my state ADAP program, I had to stop taking my medications. My blood tests 3 months and now 6 months after stopping my medications show a viral load of 4000, and a CD4 that has ranged from 675-750. My physician has advised me to stay off of my medications, and that if and when the time comes, I should be able to start back up on the same combination, or a simular one with no issues at all. What would your advice be, and are there any concerns about this treatment strategy? I am reemployed, and covered by insurance again, so medication costs are not an issue for me. Thanks for your time, and I look forward to an answer.

Response from Dr. Young

Thanks for your questions.

First off, with your current CD4 cell count and viral load, I'd agree with your doctor in holding off on resumption of HIV medications.

Given that you had an undetectable viral load while on your last regimen (and importantly undetectable around the time that you stopped), there's little reason to suspect that you have any significant drug resistance to your previous medications. This indicates that you likely have non-resistant virus currently and says that when the time comes to resume treatment, that you could resume your previous regimen, or a more contemporary regimen.

While your regimen worked in the past, newer options include more potent protease inhibitors (ritonavir-boosted ones) or non-nukes (like efavirenz) in combination with fixed-dose combination nukes. All of these have the potential for much lower pill burden and even once-daily options.

But, for now, I'd not be rushing into restarting treatment. Certainly continue to get periodic medical and laboratory monitoring- it's my ongoing hope that as good as newer medications are now, that we'll have even better ones in the years to come.

Good luck, have a happy and healthy new year. BY

tcells decline but viral load remains constant
Illness & possibility of resistance during initail phase of treatment.

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