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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
           
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Next Treatment??!!
Oct 22, 2004

I have been positive since 1987. I have been on treatment since 1991, starting with AZT, then AZT,DDC and lastly AZT, 3tc and DDC. When the PI's came out I started on Saquinavir, DDI and D4t, then switched out Saquinavir for Fortavace, DDI, D4t. I never reached undetectable and consequently show some resistence to most all these drugs.

Now for the last two years have been on Sustiva, Kaletra, Viread and 3tc.

As you see it has been a long road. ....but have never been sick. My t-cells are from 300-500.

My problem is that my last VL came back at 121 after almost two years of undetectable. I am having it rechecked to see if this is the start of a trend.

I am very concerned that I have no options if I am starting to fail the current regime. Do you have any suggestions of what I should consider switching to if it come to that?? And how high can my VL go before I should consider a switch?

As always, you are a blessing

Response from Dr. Henry

A viral load of 121 is called a viral blip and often is followed by a viral load back below the detection limit. Recently our lab switched the collection tube used and we have a large # of our patients suddenly having low level viral levels which we are trying to sort out. I have been getting a genotype (some can't be obtained due to low level of virus) to get a handle on the resistance picture and following closely. Depending on past resistance status even if your viral level is persistently detectable there likely is some combination of standard drugs that would have more activity than your current regimen based on resistance tests. Fuzeon and tipranavir are 2 possibilities to consider for some patients with rebound viremia and much resistance. KH



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