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HIV Drug ResistanceHIV Drug Resistance
           
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Need for resistance testing?
Nov 22, 1999

Hi. Thanks again for your invaluable knowledge and support. Here's my story:

*Tested positive 2/99. Had VL of 51,000 and cd4 of 182.

%cd4 pos. 13.0

(*Began treatment 3/99 with Sustiva, d4T and 3Tc.)

*4/99 VL = 637, cd4 = 210 and % = 14.0

*6/99 VL = 110 cd4 = 224, and % = 14.0

*8/99 VL = undetect., cd4 224 and % = 16.

*11/99 VL = 154, cd4 221, and % = ?

I had a 3-day flu with diarrhea shortly before my 11/99 testing. My doctor wants to retest in 1 month. My questions are the following:

1)Should I be looking for an alternate treatment?

2)Is there anything I can do to increase my cd4 counts?

3)Would you recommend resistance testing at this point? If so, specifically what kind.

4)Given these numbers, how long would you guess I have been positive?

Thanks again!

Response from Dr. Holodniy

1. I would wait for the repeat VL. If it is < 50, I would stay the course. If it has increased greatly, time to change.

2. This is a tough one. You should have seen a bump with the potent regimen you are on. Sometimes we have seen delayed (6 months or more to see the increase) responses. IL-2 could be tried, but your CD4 count is a little low to see large responses.

3. Resistance testing requires VL of > 500-1000/ml for detection.

4. I couldn't pin it down, but I would guess at least a few years.

MH


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