May 21, 2002
If you develop resistanceto sustiva are all the nnrti's shot? Also, on doctor santioned drug holidays if you are u.l. and have been for 3 years on current drugs,and cd's around 800 is there any way to predict how long it will take for a viral load to return and cd4's to drop?Can you get by using a pi with an nnrti and forgoing nukes for a while??? The last time I did an interuption it was more of a cycling(because of insurance problems) and it took 7 months for the load to hit 9000 but the cd'4 stayed at 850. Also, the million dollar question, does how virulant the virus is predict morbitiy or does it depend on the host? I'm so concerned because I'm having side effects from the drugs, but have never been sick, yet my ex partner who elected not to seek treatment is in really bad shape with dementia.
Response from Dr. Little
You have several questions - starting at the top, some of the NNRTI mutations do generate substantial levels of cross resistance to the other NNRTIs. I think your second question is how long will it take your viral load to return to pretreatment levels after stopping your treatment - in general, this takes 2-4 weeks. The drop in CD4 cell count can take quite a bit longer and really depends on where the viral load end up (ie after 2-4 weeks). There are some times when a PI/NNRTI regimen is used without any of the NRTI drugs, but this is rarely necessary and not a widely used treatment combination. As far as predicting morbidity, the best answer to this is really to look at your viral load (off therapy) and your CD4 cell count. The higher your viral load, the more rapidly your CD4 cell count is expected to decline in the absence of treatment. If your CD4 is high - you may have several years before you are at substatial risk of HIV related problems. Again, your doctor is the best person to assess this risk since he/she will have all of the most important data to put into this estimate. It is very important to remember that different people may progress at very different rates and that the differences in each individual's immune response to HIV may play a big role in the differences between individuals.
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