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Jun 15, 2009

Hi Ben

I recently found this study that suggests starting treatment at lower CD4 counts causes a MUCH greater risk of treatment failure. I started at around 80 T cells, with a boosted protease regimin, and have been undetectable for a year with no blips. This has reassured me, although this study is kind of worrying. Does this mean that the clock is ticking, despite my TOTAL adherence to my regimen?

The study can be found here:

Uy J et al. Initiation of HAART at higher CD4 cell counts is associated with a lower frequency of antiretroviral drug resistance mutations at virologic failure. J Acquir Immune Defic Syndr (online edition), 2009.

Thanks, Michael.

Response from Dr. Young

Hello Michael and thanks for your post.

The study that you've cited is one from our HOPS study colleagues- this study doesn't conclude that persons with low CD4s are more likely to have treatment failure, rather, it says that if someone experiences treatment failure, the lower the CD4 at baseline, the higher the likelihood of having that failure be associated with drug resistance. Additional studies would also suggest strongly that among the rare persons experiencing treatment from any of the first-line boosted PI regimens, emergence of PI resistance is very unusual.

With current treatments (in contrast to earlier days), there is very similar success rates among persons starting treatment with low- or higher CD4s. So, there is little reason to think that you're clock is ticking with regard to this.

Be well, BY

Atripla after 7 days
Undetectable but no clear pattern on CD4

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