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Desperately Seeking Undetectable...
Apr 13, 2004

Hi, Dr. Sherer.

Here's the Readers Digest on my sitch: last tested neg in June of 2003, diagnosed poz 11/14/03, started treatment 1/1/04, genotype & virtual phenotype showed no drug resistance. Stats to date are...

DATE CD4# CD4% VL ____________________________________ 11/18 367 21 255,000 12/11 305 24 214,000 12/30 193 21 876,000 1/6 248 25 68,900 1/13 232 24 7,310 1/27 247 25 2,270 2/24 238 27 1,040 3/30 261 26 (not back yet)

As you can tell from the frequency of my testing, I'm part of a clinical study. At my last visit, my doc told me that they now think I contracted "a particularly virulent strain" that accounts for the fact that my immune system took an "unusually hard hit" in the first six months of infection.

From a VL perspective, I think my regimen (Sustiva-Epivir-Viread) has had a great response in a relatively short time. But I'm anxious to reach Undetectable, which they tell me still be several months off. Also, I'm concerned that my T-cells aren't bouncing back very robustly, and that this might not bode well for my long-term prognosis.

Your take on this would be appreciated.

Best, D

Response from Dr. Sherer

You're right, you're suffering from too much information.

After three months of this regimen, you've had a 2.5 log drop in your viral load and a CD4 rise of 68 cells (6%), which is within the range of expected positive responses.

People with high baseline viral loads, e.g. > 500,000, may take as long as 6 months or more to reach the less than 50 copy threshold. CD4 cell rises can be variable.

I don't want to diminish your interest in these numbers and what they mean, nor in the trial you are participating in, as it may be of great use to you during the course of your care.

On the other hand, I would suggest that you step back one half step from these numbers and answer some other useful questions: How do you feel? Compared to your pre-treatment status, is there a difference? Are you able to take your medications reliably once a day, and in the meantime work, or move on in a meaningful way with your life?

These numbers - the viral load and CD4 cell count - are a double-edged sword. On the one hand, they are critically important, and you and your doctor will make crucical decisions based in part on their values, as well as on other criteraia. You must take them seriously, as you are doing.

On the other hand, they do not define you, no more than you are defined solely by having HIV. The art of living with HIV includes coming into right relationship with these numbers. Treat them with respect, and they can be your friends. Dismiss them or discard them, and they can hurt you. They can also hurt you if you allow them to define you, or if you obsess about them.

So lets see the next viral load and slow down. You're on a good regimen from the start, so keep working on the best possible adherence. At this moment, there is nothing to be desparate about in this story.


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