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How long will the drugs work
Jun 29, 2001

I've been HIV positive since 1993. At that time had a VL=35,000 and CD4=300. Didn't start meds till 1995 when my CD4=150 at which I enrolled in a study of (AZT+3TC + or - Indinivir). Unfortunately I only got AZT and 3TC. Took for one year CD4 went as high as 600 then back to 300 at the end of the year with my VL= 5,000. I was then given Indinivir with the AZT/3TC. Responded really well from 1996 to 2000 where my VL<50 and CD4=500(29) for the entire time I was on Indinivir. Last year I changed to Combivir(AZT+3TC) and Sustiva for the sole reason of making my pill taking regime easier. My VL<50 and CD4=650(32) on this combination. I've been religious with my meds as I'm scared of developing any resistance.

My question is of such. As I have responded so well to the drugs and have achieved a VL<50 since 1996 is there any reason that in the future (near or far) that my VL will all of a sudden become detectable? Are there any studies/cases that have shown a good virologic control and then just loose it? And finally with a continued VL<50 what is or can my life expectancy be?

Thank you, DG

Response from Dr. Young

Thanks for your question.

The durability of combination therapies is one of the new frontiers for HIV therapy. A couple of recent studies relate to your question. First, a presentation at this years Retroviral conference looked at the durability of efavirenz-containing therapy (from the Dupont 006 trial). The analysis suggests extremely good projected durability- well over six years on this regimen.

It is also known that long-term adherence is a large component of durability (if you don't take your meds, they don't work well). An important study from Fischl and colleagues at University of Miami showed that in the prison system, when therapy was administered directly (and observed) to patients, 100% achieved undetectable viral loads, well over a year into the study. What is impressive about this study is the emphasis that no matter what treatment one is given, the combinations work well; provided one takes the medications faithfully.

Overall, if you have had this kind of durability of medications (despite early dual nucleoside therapy); it means to me that you have figured out how to make medicine taking part of your daily routine- In my clinical practice, the likelihood of treatment failure seems to decrease with time for persons like yourself. Congratulations on a job well done, good luck for the future. BY


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