I've been on several ARVs in the 14years of living with HIV.ddi,d4t,nvf 1997 - 2000;combivir efv;azt,3tc and NVP 2003; azt,ddi and kaletra 2004 - December 2005. During 2005 December my viral load went up to 1,5 million and by January 2006 it was 2,8 million. Right now my viral load hovers at 1,3 million. I'm healthy, I work and exercise without much problems. I am also Diabetic (2004 October), a condition usually an outcome of Kaletra (true/false?). My cd4 count is 12cells/mm.I reside in South Africa. Can I ever get on any drug combination that will assist me to raise my cd4 count and reduce my viral load despite the Diabetes?

Yes, there are still treatment options, though they may not be available in South AFrica at present.

The most recently approved protease inhibitor in the US is darunavir (formerly TMC-114), and it is active against virus that is resistant to most current PIs, including Kaletra. In combination with the twice daily injectable fusion inhibitor enfurvitide and the best NRTIs that could be identified, one third to one half of patients had a 50 CD4 cell rise and undetectable viral loads in the clinical trials that led to its recent approval. Similarly, tipranavir also is active against virus that is resistant to most current PIs. Both drugs require ritonavir for higher drug levels.

While diabetes presents an additional problem for your and your doctor to manage, there is no evidence that diabetes per se reduces your response to ART. More likely in your case you have resistance mutations to most or all current medications, and that is compromising your response to your current regimen.

In order to give you a more informed answer, I would need more information, such as your treatment history (including the responses to each regimen), results of resistance tests (if any), toxicity, other medications, and other data. I urge you to take these questions and this response to your doctor.

In the event that you lack access to these medicines, my counsel would be to remain on ART and TMP-SMX for as long as it is accessible and tolerable, as there is evidence that your quality of life and survival are better with ART than without it, even when your viral load is so high. I might consider including 3TC in your current regimen, because it reduces 'viral fitness' and is well tolerated.