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holiday break - not undetectable anymore
Oct 2, 2000

Hi Dr. Holodniy;

Briefly. Diagnosed positive around 3 years ago. Took viracept, epivir, and zerit until about 6 months ago when lipodystrophy effects became severe enough for me to talk with doctor about changing meds. Was undetectable at that time with Tcell count around 650. Went on drug holiday for three months. Blood tests for those three months was Vl from undetectable to 116,000 and tcell of 990, then Vl of 216,000 and Tcell of 600, then VL of 316,000 and Tcell of 550. At the end of the three month holiday, Doctor switched me to Combivir and Sustiva (to improve lipodystrophy). First month my Vl dropped from 316,000 to 117 and Tcell went from 550 to 598. Just got my second month blood test and Vl dropped only from 117 to 96 and Tcell went up from 598 to 608. I'm extremely concerned that my VL didn't drop to undetectable during the second month (or even the first). Does this indicate a certain level of resistance - even though there was a drop two months in a row? Thanks for your help and answer.

Response from Dr. Holodniy

Possibly, but I would hold to the program for another month or two. We know it can take up to 6 months or more to get to < 50 copies/ml (undetectable). You are also on a new regimen that contains epivir (in the combivir). So the new regimen has two new drugs and one old one, which you might have some resistance to. Your viral load is too low now to look for resistance. If the viral load is the same or lower, but detectable on the next visit, I would hold the course. If the viral load is higher (ie > 500) on the next visit, an adjustment in treatment is necessary.

MH


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