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Is my second regimen not working also?
Mar 16, 2013

Thank you in advance Dr. Young for all you do and being here for a second opinion.

I am 50 y/o diagnosed with AIDS on 7/4/2012 and started HAART regimen immediately. In addition I was diagnosed with HEP B.

CD4 22 VL >4M HEP B >1.7M

Started Truvada, Isentress regimen and had an immediate overall good response. By 08/08/12, my counts were:

CD4 114, VL 499, HEP B 107669

After 6 more weeks things went crazy and my VL jumped back up to 17574, but my CD4 was still climing slowly and was now 132.

My specialist changed my regimen to now Pretista, Norvior, and Truvada. I again started seeing great results and by 12/04/2012 by VL dropped to 53 and my CD4 143.

I finally was told to come back in 3 months after initially going for blood work every 4-6 weeks since my doctors were trying to get this under control. After my 3 months, my new blood work as of 03/05/13 is:

CD4 176, VL 365, HEP B 369

My concern is of course my VL jumping back up. My doctors I know are doing the right thing and want me now to go for new blood work in 4-6 weeks and are concerned my VL is once again climing. All other counts however are doing well, especiall getting my HEP B under control.

It has been a long 6 months with several infections, including pnemonia, oral thrush which I have now cleared. I also have been put recently on cholesterol medicine Pravasatin and Zetia which I am taking daily since the beginning of Feb 2012.

Why do these medicines all seem to be working so well and then all of a sudden seem to be stopping? I have been told I have no resistance to any meds, but still dont understand why I am not undetectable at this time. My fear is I am once again going to change regimens to another within the first 6 months. Is is possible that no regimen will work for me? Will my doctors run out of options?

Thank you once again.

Response from Dr. Young

Hello and thanks for posting.

I'm not sure I would conclude that either of your regimens has failed. You had a huge initial HIV viral load, and it can take many months for such patients to reach the very low undetectable threshold of today's tests.

Since you started with a HIV viral load of >4,000,000 and in August had a VL of ~500, you experienced a drop of more than 99.99% (or 4 log10). This is entirely indicative of high potency of your medications. Indeed, I wonder if this coincided with one of the infections that you've mentioned.

I'm curious about whether your VL test of 17500 was confirmed. Was resistance testing done at that time? If no resistance was detected, I'm suspicious that this might have been the result of an infection or lab error.

If you exclude this test, your viral loads show the persistence of low-level viral load (~100) that would be expected (if emotionally disappointing) in someone with high baseline VLs like you.

I hope that's helpful, feel free to write me back anytime. BY



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