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confused about what to do
Jun 16, 2010

I am currenty taking Trizivir, which according to my doctor, I have been resistant and /or sensitive to all the drugs in Trizivir for the last 6 years or so, for the last six or so years, my viral load has see-sawed from 150 to 800, where is it currently...the same with my cd4, which is now 280...they want me to change my regimen to Intelence, Isentress, Presista/Norvir...is this combo good, do I need a strong combo, if I was resistant for so long..why isnt my viral load much higher...is my body doing some of the work at the cost of my immune system..when first diagnoised, my viral load was only 10,000...but my cd4 was 130...hence the reason we started meds, the Trizivir...the doc said that I probably have cross resistance to other no-nukes...and this combo was probably one of my last options...I'm really concerned that she may be not quite correct..do I really need this drastic (my words) new combo...could I take out the Norvir/Presista...and do well...or ad it later if needed. I know its a lot to figure out, I just wanted to give you as much info. as possible...please help if you can, any info is apreciated.

Response from Dr. McGowan

Thanks for your question. I am sorry you have to make this tough decision.

I agree with your doctors that a change needs to be made. Although you are taking trizivir you are not getting the full benefit from it. The virus is still growing, infecting new CD4 cells and developing further resistance. Your viral load may be on the low side because when the virus mutates to escape the medicines it comes at some cost. The mutations may slow down the virus...it can survive but not thrive. It is just like a soldier in battle...s/he has to wear his/her armor to survive but can't move around so easy. Eventually the virus will add more mutations that will make it grow better and the viral load usually creeps up as time goes by. Without the results of your resistance tests I cannot comment on whether or not a specific combination would work for you. However in the combo of meds you mention, if you drop the Norvir/Prezista it would only leave you with 2 drugs, which is not going to be enough to keep the virus suppressed. Have a good discussion with your doctor to be sure that she knows what your concerns are and that you are monitored closely during the transition to new meds.

Best,

Joe



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