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RE: How Long can you stay undectable?
Feb 11, 2006

Hello I was interested (and a little worried) to read your reply to the question 'How long can you stay undetectable?' (31 Jan 05). Like the previous poster, I too was diagnosed in Feb 05, and began medication in Mar 05. My latest results are CD4 444 (26%) and VL u/d. I've been u/d since April 05. My reason for concern is that you stated that it is possible to remain undetectable 'for years' if adherent. I may be reading this wrong, but I take this to mean that an increasing viral load is inevitable at some point. I find this perplexing because I've been led to believe that all being well I could still live a normal lifespan (I'm 33 right now). Will it not be possible to remain undetectable for a normal lifespan as opposed to "years"? I would appreciate your thoughts on this as my current medications (sustiva, tenofovir & epivir) have been very good to me and I'd like to know if they will eventually (or even inevitably) stop working for me.

Response from Dr. Wohl

Thanks for this great question. You are astute to detect a bit of hesitation in my previous answer. Treatment failure is, unfortunately, common. In some clinics, treatment failure rates have been in the double digit percent per year. Certaintly, some of those who experienced virologic failure (that is an increase in their viral load) may have had difficulty staying on schedule with their meds and many studies suggest that such problems are a leading cause of suboptimal treatment results.

But, let's say adherence is not an issue. How long will therapy work? You are 33 years old. Will it work for 10 years, 25 years, 50 years? Ten years seems reasonable based on data we have on people on triple drug therapy (which became available around 1995). But, we just don't know if therapy can keep the virus suppressed until you get old and gray.

However, even if your current (excellent) regimen keeps the virus under wraps for 10 or more years and then fo some reason the viral load increases consistently above detectable limits (who knows how we will be monitoring viral load in 10 years!), then another regimen will be able to be prescribed to give you another 10+ years - and soon. This does not account for major advances in therapy or even a cure.

I am not pessimistic and believe firmly that given your committment to health and access to meds you can and will grow old. Whether you will do so on tenofovir + 3TC + Sustiva (or any current regimen) is where I become a bit skeptical. The future IS bright!

DW



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