Mar 30, 2004
Hello. I would be very thankful if you can give me your opinion about my case. I was diagnosed hiv + on april 2001. Since then I've been taking Sustiva/Videx/Coviracil. My inicial VL was 40,000 and my cd4 420. In two weeks my VL dropped to -50. I have two questions. My VL stayed at -50 for over a year. But the last four tests showed a liitle increase. These are my last 5 #: may '02: -50, agoust'02: 67, october'02:97, december'03:117 and february '03:122. What do you think about it? Does it mean resistance? My doctor told me she's not worried about it 'cos de VL is still very low. And in 6 months it went up just a little. She calls it "blip". What should I expect? My second question is regarding my cd4 count. Since I've been diagnosed it was almost stable at the same #'s. Why didn't they improve? My last cd4 was 470. They always were at the same range. WHY? In almost two years I only have a better cd4 count once (670). Wasn't it supposed to see an increase in the cd4 cells after starting treatment? Why didn't it happen to me? I also want to know if Sustiva is supposed to be taken on an empty stomach. The only side effect I had since I started this regimen was dizziness. I still have it once in awhile. So, my doctor told me to try taking Sustiva with food. I even took it with high fat food. Do you think I could get more benefits if I take them on a totally empty stomach??? I always thought that I could take them with food untill I read the contrary a couple of weeks ago. I'm a little concerned about the increasing in the VL and the reason of having almost the same cd4 cells after 2 years. Thank you so much for considering my question.
| Response from Dr. Henry
The levels of Sustiva can be increased with food (particularly fatty foods) leading to more side effects but perhaps more activity as well. Persistent blips are a concern but yours seem to be low-level. If a patient has RNA readings like yours I often consider adding another drug or switching the Sustiva to a ritonavir boosted regimen. Some patients don't increase their CD4 counts despite good HIV control-very frustrating. There may be inadequate thymic capacity in some cases but usually we can't figure out why. I sometimes change the regimen around (often to a PI based treatment) on a trial basis (6 months for example) to see if the CD4 response improves (switch opens depend on past treatment history and resistance status). KH
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