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when should vl be <50 copies
Aug 24, 2004

I was off meds since June 2001. I stopped sustiva 1 week before abc and epivir. (At that time you were mentioning adding a pi before the sustiva drop, but it wasn't as clear then as it is now that that should be done) MY t's had a slow decline from 801 and 35%, to the time I restarted on aug 01, 2004 when they were 373 and 31%. I kept on delaying restarting meds bec my % was always good and not changing much and my vl was anywhere from 2,000 to 20,000 off meds and was recently only 12,000 on june 2004. Thankfully I read one of your responses where you said with a cd4 # decline, you should sometimes forget about the % and react to the actual #'s.When I restarted on 8/01 04 my vl was 64,000 and cd4 373 at 31% so I'm glad I restarted on sustiva, viread, emtriva. SIXTEEN days on meds and my #'s are 377, 28% and vl 210 copies. I know I should be aiming for a <50 vl. When would you sugg. a possible med change if it's not achieved.? (I hope my 1 week off sustiva while still on abc and epv. didn't cause any harm. Your thoughts are very much appreciated..Sincerly, LUke

Response from Dr. Sherer

When, after resuming ART, should one expect to achieve a viral load below 50?

In general, I would allow 6 months to achieve that threshold. In your case, knowing that you maintained a viral load of 2,000 to 20,000 while off meds, I would probably shorten that interval to 3-4 months.

With your low level of viremia while off drugs, it seems unlikely that any resistance mutations to ABC and EPV (3TC) would have occurred as a result of stopping the EFV one week in advance, which is what is now recommended when patients stop EFV or NVP (or a PI can be added for 1-2 weeks).


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