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Migration for Trizivir
Mar 22, 2006

I am a 55 year old male diagnosed hiv+ as soon as testing was available. I declined treatment for almost 10 years at which time I started on d4t, 3tc and Crixivan. I maintained an undetectible viral load and a T cell leve around 500 on that combination for over 7 years. At that time my Dr. suggested moving to Trizivir as a simpler regimen. After a bit more than a year my Tcells have slowly declined to the upper 300's and my viral load has risen to the upper 500's.

My Dr. wants to do a pheno/genotype test before making a decision on our next drug change. I'd like to know if 1) you feel the test is necessary and 2) what treatment options you might suggest from here on out. Otherwise, I'm in excellent health and condition. I never had a tolerance problem with any of my previous meds and I have excellent compliance to any regimen I'm on.

Thanks for your time and input.

Response from Dr. Young

Thanks for your post.

First off, assuming that you've been adherent to your current drug regimen and it's diet/drink restrictions, the rising viral load is concerning for the real possibility of emerging drug resistance to one or more of your medications.

As such, yes, if you were my patient, I'd absolutely want to get the best possible information about the resistance pattern in your virus. In our clinic, we routinely obtain combined genotype/phenotype testing in patients experiencing virologic failure of HAART. This information is essential in deciding what the next treatment regimen should be. In my opinion, it would be suboptimal care to make these decisions without an attempt to gather the resistance information-- hence, I'm reluctant to make strong predictions about what your next best regimen should be.

Because of the risk of having nucleoside resistance, I'd not recommend the use of Trizivir following failure of a d4T/3TC-based regimen at all. It's quite possible that you have compromised potentcy of all three of the drugs in Trizivir (AZT, 3TC, abacavir). It's more likely that a ritonavir-boosted PI regimen with at least one new nucleoside might work fine with fewer pills and fewer doses than you're currently taking.

So, yes, insist that your doctor confirm your viral load increase and obtain a resistance test before switching. Let us know what the results of these tests show. Good luck, BY



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