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Viral Load resistance and med change
May 21, 2002

I am a 23 year old black male. I started meds in December 2001. I started Kaletra and combiviar. The stops the meds in about three weeks into therapy and I was hospitalized because they thought I could have lymphphoma and my acid levels were high. I started meds again. My intial readings were CD4 count 43 and VL over a million. In March my CD4 was 275 and VL 600. However I had a bad reaction to combiviar. My white, red and platlets dropped. I had 3 transfusion while taking combiviar. They stopped my meds in March. I was off about two weeks. My CD4 count held constant but my VL went up to 90,000. I started taking 3TC and D4T with Kaletra about March 20. My labs taken on May 2 was CD4 275 and VL 10,000. My doctor was disappointed that the VL was not lower. Also some liver enzemye is abnormal. They think I should take a drug resistance test. Do you think I am drug resistance? I always take every dose of medication. How long should I give the new medication combination to work? If so what drug combination would be good to help with the drug effecting my liver and to get the VL back down low. Thank you

Response from Dr. Little

While I cannot tell you that you do not have drug resitance, it is not necessary to invoke drug resistance to explain your problems with the drugs. It is not exceptionally rare that it takes a few tries to find a regimen that is well tolerated and does not cause side effects that are intolerable or dangerous. As long as you are starting and stopping your drugs under a doctors supervision (and hopefully starting and stopping all at once), I think the risk is low that you have developed drug resistance. It would be fairly easy to do a drug resistance test however, which might be worth while if you have been on suboptimal treatment for longer periods of time during all of this starting and stopping.

Also, although I do not know how long you have been infected, there are some people who get infected with drug resistant virus and thus do have suboptimal responses to treatment. Again, if your viral load is still detectable, a resistance test would tell you whether you have resistance detectable following your recent trials of these medications.

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