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Switch or wait for Resistance Test
Nov 8, 2004

Since discovering HIV status 7 years ago, I have had success with meds and have always maintained UDL with high CD4 count (in the 900s). I only switched meds over the years for side effects reasons. I have been taking Sustiva, Ziagen, and 3TC for about the last 4 years. Just recently my VL started to go up. 3 tests in the last 2 months showed <200, 223, and now 303. I am considering removing the 3TC and replacing with 300mg of Reyataz and 100mg of Norvir. The logic being that it is most likely the 3TC that has become resistant. The other option is to wait until VL goes above 1000 and then do resitant testing. I would be interested in hearing your thoughts and recommendations. Thanks.

Response from Dr. Henry

We often can get resistance test results in our lab with viral loads in the 200+ range so that is worth trying to see if you can demonstrate some level of resistance. With a high CD4 count and low viral load your chances for a clinical problem for the next several years are likely very low. The issue is maximally preserving future treatment options by avoiding resistance(by adding/switching meds now) versus not using up any new drugs/classes for the time being. You may want to see if your lab has recently switched its processing to PPT tubes from the standard EDTA tubes which can result in sudden appearance of low level viremia of uncertain significance. I generally go for suppression if the viremia is confirmed particularly if low level resistance is noted (tenofovir, FTC, AZT, ddI are some NRTI intensification options depending on past RX and resistance info and boosted atazanavir is an attractive PI Option--? whether to continue the Sustiva or save for later if no resistance since there may be a negative interaction between atazanavir and Sustiva). KH



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