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Am I resistant???
Jan 5, 2006

After being undetectable for two years, I had a spike in my viral load to 554 this past October. Another test a month later showed my viral load had increased nearly five-fold to 2514. (My CD4 remained a rock at 880.) My doctor decided it was best to go off my Kaletra/Combivir cocktail untill a genotype could be done for resistance. Well, the genotype failed twice because suddenly my viral load has now fallen beneath 400. My doctor insists it's best to stay off my cocktail and do another CD4/viral load check in 3 to 4 months. I haven't been able to find any research for either a "yay" or "nay" at this treatment approach, but I have to wonder. Or, have become so bonded with my cocktail that I'm experiencing emotional withdrawal? I feel perfectly fine otherwise.

Response from Dr. Sherer

I would first wonder whether there was any change in the intensity of your adherence to this regimen during the time that you had consecutive viral load elevations. And I would follow that question, whatever the answer, with the reminder to you that adherence is the one variable that is entirely within your control. Whatever other direction these events take you in, you will need to be as close to 100% adherent as you can possible be.

It sounds like the consecutive viral loads of 500, and then 2500, were not mere 'blips'. I am surprised by your description of your doctor's suggestion, since it is always recommended at a time of new viremia that the patient have the resistance test obtained WHILE ON THE CURRENT ART REGIMEN, in order to define the new mutations (if any) that have formed. I am puzzled by the instructions to do otherwise.

Having stopped the regimen at a time when you CD4 cells are 800, there is good evidence that it is safe to continue to withhold the ART and observe, with the intention of resuming the regimen when your CD4 cells fall to a range at which you and your doctor choose to resume treatment, e.g. 350 CD4 cells or so.


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