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HIV Drug ResistanceHIV Drug Resistance
           
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Am I developing resistance?
Jul 27, 2007

I am on EFV,3TC and TDF. My CD4 has been going up and down.It was 536 in JAN,883 in April and now on June 23rd it was 753.In Kenya its not possible to go for resistance testing so we are just groping in the dark with my clinician.Am kindly asking you to tell me atleast two 2nd drug options that I can change to for am now getting scared and I want if this regimen is failing to be in the know how of which medicine I can change to for its my life and I don't want a doctor to just prescibe a regimen to me and yet I want one whose success rate has been proven after the first regimen fails. Thanks and God bless you.. Mercy

Response from Dr. Sherer

Thank you for asking this useful and important question! No, I do not think you are developing drug resistance on the basis of the CD4 cell counts that you describe, and I do not think you need to change your medications at this time.

It is quite important to understand that there is greater variability between CD4 cell counts at levels above 400 cells. Your CD4 cells suggest a good response with an increase of 200+ cells. I would simply reassure you and urge to continue to take all of the pills as they are prescibed without interruption.

If you and your doctor have access to a viral load level, that could be done to reassure you that you do have optimal virologic control. We do know that the use of clinical signs and symptoms, and CD4 cell counts, without viral loads, is a less accurate means to monitor ART and identify patients as early as possible who are developing resistance. In two recent studies, the use of CD4 cells and clinical outcomes led to a misdiagnosis of virologic failure in 35% of cases (in one study) and 50% in another study.

Nonetheless, your situation is consistent with successful treatment and full suppression, and the minor variability in the most recent counts, e.g. the decline from 883 to 753, does not necessarily imply virologic failure. You and your doctor may also be able to repeat the CD4 cell count, to see if a downward trend is evident, or if it was just this type of variability, which can be +/- 15% from the previous value. You can also look at the percentage of CD4 cells.

I urge you to talk to your doctor about these issues.


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