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HIV Drug ResistanceHIV Drug Resistance
           
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2 blips in a row
Jul 24, 2001

I've been on Sustiva/Combivir since September 2000. Baseline VL=13300 CD4=124 21. Became undetectable at 3 months with CD4=225 26. My last 3 tests are VL<50 CD4= 239 20, VL=82 CD4=213 24, VL=325 CD4=240 21. Everything I've read on this forum tells me that I am becoming resistant. My CD4 count and percentage are all over the place. My Doc says not to worry and will check again in 3 months. Is 3 months too long to recheck? And I would like your opinion on the screwy CD4 numbers. Am I just over reacting? Thank you very much!!

Response from Dr. Little

There is very good data to suggest that the best time to "rescue" someone from a failing regimen is early in the course of failure. For this reason, I would agree that you have cause for concern. I am less concerned by your CD4 cell counts - the percentages have improved on therapy and are not really jumping very much. The CD4 cell count changes often lag 8-12 weeks after changes in the viral load, so seeing things look relatively stable is not such a surprise.

While I cannot direct your management from this limited exchange, I can support you in your concern that this may the early warning that this drug combination is not going to work for you. I have tended to follow people a bit more closely than every 3 months in this situation (given the current trend, a repeat in 1 month would not be unreasonable). But this advise must be tempered with reality - some insurance programs will not pay for viral load monitoring as frequently as we would like - I would stronly suggest you discuss your options with your doctor - resistance testing will become an option as soon as your viral load is detectable above about 500-1000 copies.

My biggest advice - do not miss a single dose - you are clearly right on the border of being suppressed and if there is anything you can do to improve the situation - now is the time to do it.

Good luck.


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