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HIV Drug ResistanceHIV Drug Resistance
           
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Resistant With Good TCell Count
Feb 11, 2004

Let me start off by saying THANKS for contributing to this Q&A forum. As an HIV+ person, it helps to have a sounding board for my own questions, as well as listen to the answer to other people's questions.

I am a 35yo male, and have been HIV+ for the past ~15 years. Throughout that time, I have had to change HAART regimens several times due either to toxicities or resistance. My latest regimen (Viread, Videx EC, and Epivir)has also become resistant and my viral load is slowly climbing (currently at ~45,000). However, I continue to have a strong TCell count (>700) for the past 6 months or so. My doctor and I have have chosen NOT to switch therapy due to my strong immunologic status. The only drugs that my HIV is not resistant to are PIs and Fuzeon.

What ar your thoughts and recommendations?

Best regards, Patrick

Response from Dr. Sherer

You are in a common situation, i.e. ongoing low level viremia, now increasing to levels above 10,000 copies/ml, but strong and sustained CD4 counts well above 350 cells/ml.

You and your doctor are following one of the options open to you, i.e. staying with your current regimen in spite of resistance mutations and ongoing viremia.

It is likely that your current virus has some reduced fitness, i.e. is somewhat impaired due to the resistance mutations, and thus less able to cause disease progression. In such a setting, it may be reasonable to observe your T cell count and viral load, and, if there are no major changes, to stay with this regimen.

On the other hand, the fact that you are not resistant to PIs means that at least one more effective regimen is available to you, i.e. a true dual PI, such as LPV/r + SQV. In one study, the combination of RTV + SQV in naive or NRTI experienced patients resulted in 5 years of excellent viral suppression in 73% of patients.

You may also have one or more options in the NRTI class, e.g. tenofovir or abacavir, which often have efficacy even in the presence of some NRTI resistance mutations.

Your best option is to keep watching your T cells and viral loads with your physician, and consider your options if a change occurs.


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