I am a female in my 20's with HIV/AIDS. My T-cell count is 50 and viral load is 190,000 cps/ml. I know for a fact that I was infected 3 years ago, does this mean I have a mutated, aggressive strain of the virus, and if so what would your recommend in the way of drug therapy.

Our currrent doctor put me on Viracept, Epivir and Zerit. Along with Septra which is causing me extreme itching and pain which Benedryl and Claritin are not relieving. Does this combination sound acceptable to you, or is my doctor, not experienced enough. Thank you

The triple combo you are on sounds reasonable - it has been studied and usually works well. So far, so good.

As for whether you have a resistant strain from three years ago - without a resistance test, we cannot say for sure. So far - in population surveys in the larger cities in the US and Europe - the occurence of resistance has been around 5% - meaning 5% of people who have never taken an antiviral have a virus strain showing some resistance to at least one of the commonly used meds. Which also means that the combination you are on should be fully potent against your HIV at least 95% of the time. And if you have already started the meds - you might be able to tell without a resistance test if the combo is working - just from the initial drop in the viral load. If your viral load went from 190,000 to about 19,000 or lower by the end of the first month - you are "on track" for a good response. And it should continue to drop from there - going below 400 usually by week 12 to 16. And below 50 by around week 24.

As for the itching - there is more to do that just put up with it, especially if the meds you are taking to control the itch aren't working. One approach has been to simply take "single strength" Septra instead of the more standard double strength - since the early studies comparing these two found fewer side effects at the lower dose but similar success rates in preventing the PCP pneumonia. And one study showed that if you slowly build up the dose of the Septra, taking a tiny amount on the first day by using a liquid form, and building up over 2 weeks, you can often help the body learn to tolerate the medication. And if that isn't successful in controlling the itch, there are alternative approaches to the meds that can also prevent PCP. But you don't need to live while enduring pain and scratching...

As for whether your provider is skilled enough, it is hard to say. But the meds you are on are certainly some of the ones most commonly suggested by those who are skilled. Now comes one key to testing this skill level - which is to ensure that you are monitored correctly, to be sure these meds are working well, and any side effects are handled correctly -- since there are options.

good luck. CC