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Continuing treatment with certain rebound of viral load?

May 22, 2001

If you are taking a triple combination, and viral load rebounds to 7000 but cd4 dont move (over 700), would you change inmediately or wait until next tests. I read somewhere that sometimes you can mantain a certain treatment even though your viral load rebounds a little, in order to gain time and not go through treatments so fast. Maybe they are not strong enough to supress viral replication completely but they will be able to mantain you if your condition is decent enough still some time. Is this a wrong strategy? Thank you

Response from Dr. Young

The answer to your question depends alot on where you are at with regard to your disease and available treatment options. Your are correct insofar as the idea that incomplete viral suppression is better than no suppression; that careful selection of drugs and timing of their use will potentially lead to a longer period of effective therapy.

However, this statement comes with serious qualifications. If you have persistent viral loads of about 5000, it would be reasonable to assume that you will have ongoing viral evolution. Such evolution in the face of drug and selective pressure will likely lead to higher degrees of drug resistance and importantly, cross resistance to other HIV medications. This being the case, it is usually safer to switch to a more potent regimen (if available) or even to consider treatment discontinuation.

Again, your disease status also affects this decision; patients with advanced disease and low CD4 counts usually benefit from ongoing treatment; those with very high CD4s can sometimes defer on continuing.

Getting information about the status of the virus, with regard to drug susceptibility (genotypes or phenotypes) can sometimes factor into the decision making process. Best advice is to continue to ask questions, continue to get medical attention and laboratory monitoring.

Hope this helps, BY

Second opinon: Stopping meds?
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