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Suggestions about how to start, for my Physician too
Apr 20, 2005

Hi, I just got my lab tests today, and here are the results: Viral Load: RNA VIH-1: 20367 copies Log10(RNA) 4.31 and CD4 count: 276. I haven't started treatment yet, but I guess that I will soon, so here are my questions: 1. Should I start treatment right now? 2. Can you possibly tell me (aprox.) with those numbers above, how long do you think I have been infected? I'm really curious about it, I know it won't be an exact answer but I'd like you to tell me something about it. 3. What does the "log" in my VL mean? What does it specifically mean in my case? 4. What are your suggestions about starting treatment? I mean, what do you think that would be the best mix or "cocktail" considering I'm studying, I have an office work, I'm 27 y.o. and in good general health? Thank you very much for your suggestions.

Response from Dr. Wohl

Hi

The tests reveal that your CD4 cell count is significantly lower than what is considered normal in a healthy person. The average CD4 cell count of such a person is around 1000.

The viral load is how much virus is found in a mililiter of blood plasma (the liquid part of blood without any cells). Remember, this is just a measure of the blood viral burden, not how much virus is in organs, lymph nodes, genital secretions etc. The lower the blood plasma viral load, the lower virus tends to be in these compartments.

The log10 viral load is another way to express the viral load number. All it is is the power to which the number 10 is raised to get the viral load. The log10 of 100 is 2.0, of 1000 is 3, of 20367 is 4.3089.

You have several good choices as far as therapy. I find many people like once daily regimens. Right now once of the easiest combinations are:

Tenofovir+FTC (Truvada) + Sustiva, or Abacavir+3TC (Epzicom) + Sustiva

Both of these are 2 pills once a day. The major differences between these two include side effects (about 5% risk of hypersensitivity [like a severe allergy] to abacavir, much rarer darkening of the skin with FTC) and the pattern of resistance that can develop if drug failure emerges). I tend to favor Truvada.

If you do not tolerate Sustiva (can cause vivid dreams and/or grogginess that generally resolves over the first 4 weeks), could consider a switch to Viramune but I usually give this agent twice a day. Most people can tolerate Sustiva and I would recommend taking it at night, and maybe start during a break such as a vacation. Sustiva can cause birth defects, so if you are a woman and interested in becoming pregnant, this drug is not for you.

Good luck

DW



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