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3 blips in a row
Oct 1, 2007

After 9 years of hiv treatment with undetectable viral load and t-cells between 450-600, my last two viral loads 3 months apart have come back detectable at 189. my doctor has suggested we wait 3 more months and repeat the labs and if still detectable the 3rd time switch regimens. He has explained to me that my count is too low to do any resistance testing that we will just try a new combo. In 1998 I started a regimen of combivir and crixivan but switched after 3 years to trizivir to get away from the diet restrictions. After 2 years on trizivir my doctor suggested we add viread due to a study suggesting trizivir was not strong enough.I have been on this trizivir/viread combo fo 4 years. First of all should I wait till the viral load gets high enough for resistance testing or switch blindly to keep from builing more resistance. Secondly , any suggestions for my next regimen

Response from Dr. Wohl

Your viral load really came back as 189 twice in a row? That the viral load was the exact same number twice is a coincidence. Regardless, I would also be concerned about emerging resistance. Although the viral load is low it usually does not hurt to try to get a genotype. I have found that sometimes even at such low levels the test can be performed. The only issue is cost.

If the viral load again is elevated, I can see the benefits of switching. What to switch to is not so easy a question. I'd consider a ritonavir boosted protease inhibitor and keep FTC or 3TC on board. To this I would probably add tenofovir as it is unlikely you are resistant to this med.

I would not wait another 3 months. Get the viral load now.

DW



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