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Benefit to not Changing regimes
May 30, 2006

Dear Dr. Young

I really have benefited from the tone and care of your answers. I am somewhat recently diagnosed and sometimes scared to death. Your manner has been very comforting for me.

Here is my question. I was diagnosed last november (496 t cells, 10%, vl 76,000). I started treatment (trizivir) in feb (cd4 569, 19%, vl of 345). in may my numbers were cd4 526, 15% and vl of 54. My doctor (who is very experienced in treating hiv infection) wants to stay a little longer with the trizivir because it has been easily tolerated for me. he told me that he is very happy with the suppresion of the viral load, but is a little disappointed with the lack of improvement in %. He also shared that it his experience that trizivir is viable with treatment naive patients (which I am/was), but it can be slow in getting the desired results. I am 43 years old. What are your thoughts about this strategy. Is there any potential long term harm to my immune system by waiting until august to check results and am I at any risk of hitting a crisis point?

thank you in advance. again I can not tell you the amount of piece of mind you have provided me these past months

Response from Dr. Young

Thank you for your kind words and post.

Overall I think that you may be over interpreting your labs- since you've only been on treatment for 3 months, I wouldn't necessarily expect huge changes in CD4s; I'm curious- your initial viral load was 76,000, but only 345 prior to starting Trizivir?

I do agree that your viral load of 54 at 3 months is a very good one and while I share a degree of disappointment that your CD4% hasn't gone up much, I'd repeat the test before drawing any conclusions. As you can gleen from my first comments though, I don't think that I'd weigh the 3 month CD4 results very heavily. As such, waiting until August to repeat labs would be fine with me.

I generally don't use Trizivir as first-line treatment because it hasn't performed as well as other three drug (2 class) regimens; however, for selected patients, especially (if true) for those like you with very low baseline viral loads, Trizivir can be a very usual and easy to take option.

I hope this is helpful; write back if you have any additional questions or details.

Best health, BY



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