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HIV Drug ResistanceHIV Drug Resistance
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Jul 24, 2004

My doctor has indicated that he may switch me off combivar because the last two lab results showed a decrease in my tcell count. they were at 262 and decreased slightly. he said that combivar may be preventing tcells from regenerating as it is a inhibitor. Have you heard of this. i am also on kaletra and have only being on drugs 9 months and my viral load went from 48,000 to zero after just 6 months. I have no side effects from combivar and find it an ok dosage to take. I am also on Septra and he said if tcell count goes above 300 he will take me off this. what are you thoughts ? thanks in advance.

Response from Dr. Sherer

While I will answer your question, I urge you to talk to your doctor about these recommendations. The important thing is for you to discuss the issues and come to agreement on the next step.

It sounds as though you have achieved good viral load suppression with this regimen. That is very positive, so I urge you to continue your good adherence to whatever regimen you decide upon next.

There is much information that I would need to provide an accurate answer to the question you are asking. That is another reason to take this question to your doctor. He or she has that information, and I don't. For example, I don't know if this is your first regimen or not, nor do I know if you have had a resistance test in the past that might indicate full or partial reduced susceptibility to any othe medications in your regimen. I also don't know what happened if and when you were on other regimens, i.e. did you respond, and were there side effects.

Finally, CD4 responses to a given regimen are variable. When they are less than expected or hoped for, there are not clear guidelines on how to respond. One strategy, as your doctor is suggesting, is to change some or all of the regimen. As substantial CD4 elevations are common with Kaletra regimens, a change in the NRTI backbone may be a reasonable response. However, this has not been proven to be an effective way to elevate CD4 cells in a clinical trial.

I also don't know what alternative NRTI pair (or other med)is being recommended, so I can't comment on the merits of the alternative. As above, take these questions and discuss them with your doctor.

Finally, the CDC guidelines suggest that PCP prophylaxis can be stopped after 3 or more months of good viral load suppression, good adherence, and a CD4 cell count above 200. However, some physicians are more conservative and wait for a longer period of time or a higher CD4 cell count threshold, knowing that PCP occassionally occurs at CD4 cell counts above 200, or a CD4 cell percentage above 14%. The percent of CD4 cells may also be a useful peice of information for you to inquire about.

Wrong Dosage
viramune to sustiva

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