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Rising VL
Dec 3, 2001

Doctor while on viramue/combivir I had two vl tests, the first was 270 and the second 800 copies. The doctor added ziagen to intensify the regimen. Another test is done to see if this regimen works. Previous experience with hiv drugs are crixivan and the above drugs I mentioned. What would be the best thing to do if this regimen does not suppress the virus back to undetectable levels? Another question, is 800 copies enough to create major resistance to those drugs I am on?

Response from Dr. Young

Thank you for your question.

I think that the addition of abacavir to your current regimen, to intensify the potency of treatment makes sense. Part of the practical issues related to viral loads less than 1000, is that we are unable to determine, accurately, the genotype of your virus. In this circumstance, adding abacavir to Combivir-- to use Trizivir, should not add any pills to your pill burden and might reduce your viral load to undetectable levels. If it does not, the resistance pattern that emerges (at least early)should not be significantly different that Combivir failure.

Should this Trizivir/Nevirapine not be able to suppress your virus, the concern would be the emergence of resistance mutations at RT codon 184 and/or NNRTI resistance. The later is of particular concern, since usually, resistance to one NNRTI confers resistance to all of the NNRTIs. Certainly obtaining a viral genotype or phenotype at this point would be worthwhile; second-line treatment options would depend on the outcomes of this testing. There could be several treatment options, one to use ddI/ tenofovir in combination with either a boosted- or non-boosted- PI regimen.

hope this is helpful, good luck. BY



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