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stopping meds
Mar 28, 2001

i benn positive for 5 years i was given zerit and epivir only my virol load is always less than 50 nad my t cells are 876 my doctor thinks i should stoped the meds becouse is unsual to remain undectable for so long in just one kind of meds so he claims i may do good without the meds i am very confussed help me please

Response from Dr. Boyle

This is a question many patients and doctors are asking now, especially since the DHHS guidelines were recently changed to lower the recommended starting point for CD4+ cell count to 200-350 cells/mm3 and raise the recommended starting point for viral load to 55,000 copies/mL. I agree that it is unusual to have a viral load less than 50 copies/mL on two medications and that is why we generally use three drug regimens. However, just as you have, I have some patients that have done that for many years and a study presented at the recent 8th Retrovirus Conference indicated that patients who succeed with dual therapy may get extended benefit from it. Still, almost all patients, including you, should be on triple therapy since that is most likely to give durable viral suppression. With that said, I think it is up to you and what you feel comfortable with. As long as your CD4+ cell count was relatively high at baseline (say roughly greater than 350 cells/mm3), it is reasonable to stop medications at this point and observe you carefully for any sign of a problem. If a problem occurs regarding your CD4+ cell count, viral load or clinical status, you should be started on triple therapy. Given your long-term success and tolerance of the regimen you are on, it is also reasonable to continue your current therapy with VERY careful monitoring of your viral load. If the viral load bumps, I would IMMEDIATELY either discontinue or change your therapy since significant resistance may develop which could affect future treatment options. Given your high CD4+ cell count, I would not intensify your therapy by adding another drug(s) at this point. So, it is your choice, but regardless of which one you choose you should be monitored very, very carefully. BB



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