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Switching from sustiva to kaletra? Please post, I am so depressed!
Dec 20, 2010

Hello dear doctor McGowan! I`m 38 year old male from East Europe. Started treatment - Kivexa (Epzicom) and Stocrin (Sustiva) 13 months ago (2 years after infection) and at that point my cd4 count was 368 (only 11%) and high viral load 205000. Than 4 months later cd4-382, cd8-1732, cd4%- 12,7 and viral load undetectable (less than 40 copies). 3 months ago cd4-381, cd8-866, cd4%-22,4. Last result (1 week ago) cd4-349, cd8-1260, unfortunately don`t have cd4%. Undetectable all the time (now for 9 months). 2 weeks before the last result I completed my 6 day treatment of azithromycin (every day 500mg) due to diagnosed streptococcus infection of my throat, during infection I felt bad with 5 day fever. I tolerate my hiv drugs very well with no side effects and with all perfect blood result. Healthy and feeling well all the time except mentioned streptococcus infection. Haven`t missed any dose of my hiv meds and take them exactly on 23h every evening. How long do you think will I need to improve my cd4 count? I am so depressed after my last result... My doctor told me that last result may be consequence of the streptococcus infection and I was told to go on with the same treatment but at some point to consider switching from stocrin (sustiva) to kaletra if there is no improvement with cd4. Do you think is there any benefits of switching to kaletra? I would NOT like to change drugs. Especially NOT protease inhibitors. I live very healthy life (with no chance of reinfection), do regularly sport, travel... but this is so frustrated. What generally can be the reason for not improving cd4 count after 9 months of being undetectable? Is there any supplement which I can use for improving cd4 count? Have read many topic about it recently but without clear answer. Thank you very much in advance, you are doing great work here.

Response from Dr. McGowan

Thank you for your compliments.

I do not see any reason to switch treatments at this point. Your viral load has been consistently undetectable and your Cd4%, which represents the balance of your immune system has at least doubled. I agree that the drop in CD4 number may indeed be due to the recent strep infection...CD4 cells move out of the blood (where we measure them) and into the tissues to fight infections, it can take a few weeks for them to recover to normal. This is true with or without HIV. Changes to protease inhibitors may cause a slight increase in the CD4 count, but the clinical benefit is unclear and I wouldn't change just to get a better number.

Best to you, Joe



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