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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Medication Off or Stop/Start Therapy?
Mar 20, 2003

Dear Doctor

I was diagnosed HIV positive on 17/1/1997 with CD4 294(15) and Viral Load 28,480(log 4.454) and started drugs, AZT and DDI twice a day.

21/3/97 CD4 410(22) VL 1040(3.017) 24/5/97 CD4 600(22) VL 8496(3.929) 12/9/97 CD4 680(30) VL <500(2.7) 13/2/98 CD4 574(23) VL <500(2.7) 26/6/98 CD4 401(18) VL 5,307

From August onwards, drugs were changed to 3TC, D4T, and Viraceo

16/10/98 CD4 339(16) VL <50(1.7) 22/2/99 CD4 380 VL <50(1.7) 22/7/99 CD4 448 VL <400 22/11/99 CD4 452 VL <50(1.7) 6/3/2000 CD4 432(19) VL 171(2.23)

From April 2000, I had problems on stomach pain and liver, then my dedications were changed to 3TC, AZT, and Stocrin

9/6/00 CD4 610(23) VL 61(1.79) 27/9/00 CD4 410(18) VL <50(1.7) 23/3/00 CD4 406(21) VL <50(1.7) 23/11/01 CD4 342(20) VL <50(1.7) 22/3/02 CD4 490(25) VL <50(1.7) 16/8/02 CD4 470(24) VL <50(1.7) 14/2/03 CD4 497(26) VL 282(2.45)

I have 2 questions herepf:

1. Can I do mediactions off? If yes, how can I do? 2. If no, can I do Stop/Start Therapy?

Of course, these 2 must b consulted with my doctor.

Thanking you in advance for your immediate attention

Best regards

Response from Dr. Henry

When you stop treatment your CD4 count starts heading back towards its lowest level and the viral load usually heads back to its highest level. Your baseline (pre-treatment levels weren't too bad but I would still be uncomfortable stopping meds). For one thing you likely have some modest resistance to the NRTI class with possibly some low level resistance to either Viracept or Sustiva. An alternative would be to switch your meds around a bit or watch how you do on your current regimen (in the US we might consider adding tenofovir or abacavir in this situation). A trial off treatment is not out of the question but stopping the Stocrine (=Sustiva) can result in resistance due to its long persistence in the blood. If you stop meds I recommend stopping the Stocrine 3-4 days before stopping the other meds. I don't recommend start/stop therapy with that regimen for the same reason (too risky to develop resistance to Stocrine). KH

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