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Failing on Truvada and Efavirenz
Nov 29, 2009

Doctors!! My sister was diagnosed HIV positive over five years ago and initiated ART [truvada and Efavirenz]and her cd4 went up to a thousand last year but since the beggining of this year her health has deteriorated and checked her CD4 now at 2cells/microlitre - Please advise on the possible altenative combination

Response from Dr. McGowan

Hello I am sorry to hear about your sister's deterioration as you describe it. If her CD4 count is 2 when it had been 1000, there is clearly cause for concern. Here are my suggestions: (1) she should find out what is happening to her viral load...if this has gone up (that is above the level of detection) she needs (2) testing for HIV drug resistance (3) if her viral load has gone up, one has to ask why? (4) Were there any issues with medication adherence? This is important since this might impact the effectiveness of her next HIV regimen. Fortunately, other treatment options exist and with the selection of an appropriate HIV regimen, close monitoring for the new treatment's effectiveness she should be able to achive immune recovery with an increase in her CD4 count and virlogic suppression. Thanks Joe

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