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Chaging medication
Mar 25, 2006

Hi! i' been doing stocrin and combivir for 3 years and been unductectable since. I just want to ask if i shoul stay with them or change to one of the new medication that came out in this time. May i ask how do i know if the virus still exist, since is undectetable. because the antibody does? But will the antiboby always be present?

Response from Dr. Wohl

If the Combivir and Stocrin (we call it Sustiva on this side of the pond) are working well to keep your viral load suppressed and your T-cell count high AND you are not experiencing any problems with these meds (i.e. side effects, lab abnormalities, missing doses), I would advise to continue this regimen without a change.

However, were you to be having trouble remembering to take your morning dose of Combivir, had a drop in your hemoglobin since starting the meds, fatigue, headaches or other side effects that suggest intolerance to AZT (a component of your Combivir), I could see a change to something more convenient (once a day) such as tenofovir that would replace the AZT.

We have learned that when people with undetectable viral loads on HIV meds stop their drugs, the viral load pops back up within days to weeks. That is how we know the virus is not gone. 'Undetectable' means that there is so few virus present in the blood that the viral load test can not reliably count them. It is like a needle in a haystack, their there but hard to find and count.

But, recall that the viral load test is a test of blood. There are other places where the virus goes. In fact, trying to count virus in the blood is analagous to trying to take a census of a city by counting how many cars are on the highways. HIV may be more readily found in places less accessible like lymph nodes.

When the body is confronted with an infection, it typically makes a series of antibodies in response. In the case of HIV, these antibodies can be measured. A feature of our immune system that evolution has provided is the ability of antibodies to hang around. Since you were infected once with a germ you are at higher risk of being infected again and having antibodies against that germ circulating in the blood may make you less likely to get sick from it again. So the antibodies stay even after the infection resolves, or in the case of HIV, controlled.

DW



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