Skeptical about a bright future.
Apr 3, 2005
Thanks for the quick responce.But my question wasn't really answered. Let me tell you more about myself so that you could access my situation better. At the age of 16 I made the biggest mistake of my life by having unprotected sex, my first sexual experience sentenced me to living with HIV.My first CD4's was 779 and a viral load of 948 in the year 1998.After starting on Retrovir and Epivir which didn't make much difference in my viral load my doctor switched me to Zerit, Fortovase, Viracept and Epivir and the results were great.My CD4's sky rocketed to 1543 and my viral load became undectable for a number of years.During this period my CD4's were always above 800.I took a break from my regimen two years ago and my last labs showed a CD4 of 480 and a viral load of 33,000.As I mentioned before that I was distraught when my doctor told me patients that are slow progressors don't do well when starting meds again. My question to you was, "AFTER starting on meds again, how many years should I look forward to." Because the way my doctor says things is like I'm going to have quick drug resistance and run out of options.I am only 25 years old and wish that a doctor could reassure me that I could live atleast 15 to 20 years more.So with that said could you tell me what to look forward to.Thank You.
Response from Dr. Young
Thanks for your follow up.
I am saddened to hear about your story and how young you acquired HIV.
I'd still hold to the general premise that your prognosis is still very good. The previous treatment with AZT + 3TC and lack of response suggests that you may have some NRTI resistance (probably the mutations we call TAMs and M184V). However, it's also evident that you had a very durable response to the second treatment regimen of d4T + 3TC + saquinavir + nelfinavir (a popular second-line treatment at the time). This means to me that your virus is entirely suppressible.
Getting a resistance test at this time (since you're off medications) probably won't reveal any significant resistance, since detection of resistance typically requires taking the medications that select the resistant virus.
Nevertheless, while I'd propose to you that newer treatments are considerably easier to take than that last regimen, when it comes time to resume treatment you'll be able to suppress your viral load again. Patients with your proposed resistance pattern should respond very well to a variety of contemporary second-line treatments. I'm not aware of any data (or reports for that matter) that suggests that slow progressors have difficulty with treatment discontinuation, moreover, persons with lower viral loads if anything, tend to respond better to treatment.
I hope this helps, BY
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