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Scared of Treatment Failure
Jan 11, 2003

I am a 45 year old male on meds 28 weeks. I am unable to find any data on extemetly high base viral loads and the ability to reach undetectable levels. My base line viral load was 1,000,000+, and cd4 of 0. (Inability to be diagnosed by 8 specialist 50,000, and HIV test physcian thought was negative) I have seen in the room of failure, and I very scared of being there again. After 20 weeks on Katetra, and Combivir, cd4 was 135, and viral load rna is 60. Ater 28 weeks cd4 was 175, but viral load was 80. The literature states one should be undetectable after 24 weeks, but this is affected by initial viral load and cd4, but no further explanation. Am I failing this treatment regime? Why has cd4 count not recovered faster? Scared ...Thanks

Response from Dr. Little

I think that a viral load of 60-80 is close enough to undetectable that I would not worry too much that you are failing your treatment. It is true that the higher your pre-treatment viral load, the longer it will take to reach an undetectable viral load, but you are nearly there. What I would think about however, is that the fact that you have not reached completely undetectable by week 24 and your baseline viral load was quite high - you may want to consider an even more potent therapy than you are on. This is by no means a recommendation that your current therapy is not adequate - only that you do need a very strong treatment and you don't want to run the risk of being close but not quite there for too long. Some physicians would consider using all three classes of antiretroviral drugs in your case or adding another nucleoside (perhaps abacavir) to your current regimen. I would discuss the relative risks and potential benefits of this with your physician and would more seriously consider this option if your next viral load or two are not clearly staying below 50 copies.


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