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HIV Drug ResistanceHIV Drug Resistance
          
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Drug Resistance
Jan 24, 2005

I tested positive after being finding out I had lymphoma. I went through chemo and it appears the lymphoma is in check. When I tested positive my 1st labs were 20 T cells and a viral load of 180000. I started my 1 st regiment of Sustiva, Epivir and Viread. That combination never got me to a undectable viral load. I would jump around from 300 to 3000 and everywhere in between. I switched and droped viread and added Kaletra and Ziagen after the doctor suggested it. My VL now is a bit better but still jumps around between 300 and 1900. I am wondering if it is advisable to try and make another switch. My T cells have maintained around 200 for the last year. It is a bit scary to think of a 3rd regiment this soon, but am not sure if that is just part of the process. Is there a point where you say time to switch? The genotype test have not shown resistance but yet the VL is still not unstable.

Response from Dr. Sherer

At this moment, I would not advise changing to a third regimen. I would suggest that you continue to try to understand what is happening on this regimen with your doctor. I would suggest doing this by 1) obtaining another genotype and, if possible, a phenotype resistance test at a time when your viral load is above 1,000 copies/ml, and 2) redoubling your efforts to ensure complete adherence to the medications (which you may be doing perfectly well, or which may still benefit from further improvement).

People with the lowest CD4 cells and highest viral loads tend to take the longest to achieve full suppression, often longer than six months. As you have not defined the time period in which this phase of your case took place, I can't comment on whether you were simply taking longer than usual to achieve full suppression. By advising your first medication change, it appears that your doctor did not think so.

You note that the genotype test "have not shown resistance", which may mean that you have had more than one test. It would be helpful to know if you had a resistance test before you started your first regimen, to detect whether you acquired a resistant virus.

And finally, you note that your CD4 cells have been stable at 200 cells/ml for the last year, in spite of the viral load ranging from 300 to 1900. I some cases in people with very low CD4 cells when they start ART, as in your case, greater elevations of CD4 cells do not occur. You may also still be seeing the impact of the chemotherapy on the regeneration of lymphocytes.

After repeat testing, it may be clear whether drug resistance is playing a role in the level of your response, as well as possible options for you and your doctor to pursue.


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