|Time to change?
Jul 30, 2001
I have been positive since 1991, and am currently taking Ziagen, Videx and Sustiva since March 1999. Just prior to the change, my VL was 120,000 and CD4 about 500. After the change, my VL dropped to undetectable only once. On the current regimen, my VL has varied between 814 and 4,995 and was as low as 1,470 as recently as April 2001. Last month, the VL had risen to 7,230, with a CD4 of 433 (the nadir). My doctor (I changed doctors in December 1999) has not suggested any change at this time. Do you think the higher viral load warrants a change in regimen? If so, what options are available?
During the period from 1992 to March 1999, I was on Retrovir, Videx, Epivir and Zerit in various combinations, as those drugs became available. My current doctor gave me a drug resistance test in December 1999 which showed I was resistant to virtually all the nucleosides available at that time. Thank you for your help.
Response from Dr. Little
I think that a persistently positive VL indicates that you may have developed drug resistance to one or more of the drugs in your current regimen. This is the perfect situation to perform another drug resistance test (a phenotype or genotype) to help guide you and your doctor in any treatment changes. I am actually quite surprised that your viral load has not risen higher given the amount of time that you have been incompletely suppressed on this regimen. I think it is a good sign that your viral load is still fairly low. There is also no urgency to these actions given your high CD4 cell count, but I have always favored selecting the best regimen which will optimally suppress your virus - since we now have the tools to help us do this better, I would use them. You did not mention any protease inhibitor experience - these may be the necessary addition to your regimen. It has been a long time since your last test, and I think you may learn a bit more with a test now. The choice of which test (genotype or phenotype) is often made by which test your provider is more comfortable interpreting - either will provide useful information to help you optimize your treatment regimen.
multiple drug resistance, poor response, cmv retinitis returns
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