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How fast to suppression is acceptable
Jan 25, 2002

Dr Little

I was diagnosed in August and started meds 1st week in Sept. Trizivir and Viracept. This is my first regimen. Base Line VL 350k CD4 71 4. No treatment, no OI's to date

Labwork done week (5) Vl from 350k down to 755, wow. Cd4 went from 71 4 to 100 6. Also told I have chronic Hep B. Liver funtion ok, anemic however. Hemaglobin 10.4. Was low to start at 12.3. ID doc had cbc checked again two weeks later, steady @ 10.4.

Labwork week (16) Vl up to 924...Cd4 up to 180 10. Liver ok still anemic in the 10's.

Next labs set for March week (28). My concern is that if the virus has not been suppressed by next lab test and the week to get the results, I may lose sensitivity to the whole nuke class.

I think I want to get the labs done no later than week 24. I take my meds at 9am and 9pm with meals for PI and supervision from wife. I have never missed, or been late, with a single dose.

What do you think..

Thank You RP

Response from Dr. Little

I understand your concern. You clearly had a very prompt and significant decline in your viral load and the failure to see complete suppression between your week 5 and week 16 viral loads is a bit concerning. While I only have a few details upon which to base this recommendation - I would think that it would be desirable to obtain another viral load test sooner than week 28. There are a couple of issues - is this a potent enough regimen for your virus, and do you have any level of pre-exisiting drug resistance such that your virus is not responding as well. Your initial prompt decline of viremia would argue against the presence of resistance, but does not absolutely exclude this possibility. I would see if a viral load at week 20 is an option. If your viral load is rising, I would investigate new therapy and resistance testing. Also - between now and then, you might want to check with your doctor if you are on any other meds to confirm that there are no drug interactions which might cause you to have a lower than desired blood level of one or more of your drugs.


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