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HIV Drug ResistanceHIV Drug Resistance
           
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High VL low CD4
Mar 13, 2000

Dr.Holodniy:

I have been HIV+ for 2 years. My VL initially was 625,000copies CD4 was 20. In six months my VL went to 30,000 copies CD4 190. Next test, VL 297,000 CD4 190. We did a geneology test, found that I was immune to 3TC. We replaced 3TC with DDI, My current combination is: DDI, Nelfinavir and D4T. I have been on this combo for the past 5 months. Current count is VL 325,000 CD4 180. My health care professionals in Vancouver are re-assessing my meds.

In all this, I have not once, been ill for the past 1 1/2 years, maintain my weight, feel good, lots of energy and still put in 10-12 hour days at work, with plenty of rest. As well as diligently maintaining my vitamin intake. Any suggestions as to the combination of meds I should try next?

Response from Dr. Holodniy

It sounds from your history that you had an initial response and from the resistance report, had developed resistance to 3TC. My guess now is that if you are strictly adhering to taking these meds, you may have developed further resistance to nelfinavir. Although you have had a great CD4 cell response, you want to maintain, or increase that. You need to change regimens now. You have a lot of options, but this will be a critical change. Given your viral load, you will probably need 4 drugs (at least 2-3 new ones) to get your viral load to < 50/ml. An additional resistance test may be helpful as well.

MH


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