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Treatment question from India
Oct 24, 2006

Doc, After gettting latest lab report CD4 count 900+, our physician in India advised to stop taking medication for now and monitor. We have been taking Epivira+Nevirapine, since March of 2006 when CD4 count was 250. I did not get clear understanding as to if this is normal treatment procedure or not. Can you please give your opinion on our physician recommendation .

Thanks for your time.

Response from Dr. Young

Thanks for your follow up.

The jury on treatment discontinuations is out- there isn't any clear consensus, though a conservative view states that there is some risk of new complications and/or drug resistance following a discontinuation.

Having a lower CD4 count at the time of treatment initation is a risk factor for having a more rapid drop in the Cd4 count after stopping, though at 250, this risk is not likely to be too high.

You're physician's recommendation is similar to advice that I offered my patients in years past; many have been off therapy for several years since, without additional complication. I no longer recommend this to my patients unless there are other compelling reasons to stop medications. Because the nukes and non-nuke drugs stay in the body for differing periods, some have recommended to switch from the non-nuke to a PI regimen for a few weeks prior to stopping; this is to try to avoid generating non-nuke resistance. You can see from this that the strategy isn't straightforward at all and there's still much to learn.

(I'll add parenthetically that I trust that your not just on 3TC (Epivera, Epivir) and nevirapine (Viramune), but also a third drug (like AZT or d4T or tenofovir)).

One thing that is very clear is the need to monitor both clinical and laboratory symptoms after a treatment discontinuation.

I hope this helps. Let us know how things turn out. BY


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