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One Month Update
Feb 10, 2004

Hi again. As I've written in earlier postings, I was diagnosed last November with drug-susceptible HIV-1 (no resistance). I'm now in the second month of my first HAART regimen -- Sustiva (efavirenz) + Epivir (3TC) + Viread (tenofovir DF). Am having great results acc'd to my docs... Started with CD4 193 (21) and VL 876,000; after just 26 days of treatment, my numbers were CD4 247 (25.3) and VL 2,270.

In his last email, my main HIV doc wrote "In summary: your liver functions, kidney functions, blood parameters are all normal... you have very little reason to be nervous at this point. You have responded extremely well to medicine without any major side effects, your viral numbers are coming down nicely and all your other blood tests are normal."

Four questions:

1) My docs tell me that my really good response indicates a good probability that I will reach undetectable quickly and am more likely to stay undetectable for a long time. Do you agree?

2) Despite the incredibly fast initial drop, though, they say I shouldn't expect to reach undetectable by my next blood work (which will be done one month after my last visit). They say the speed of decrease in VL will slow down now. Is this true, and if so is it normal and therefore nothing to obsess about? And is there any benchmark I can use in guessing when I might reach undetectable?

3) One thing my docs tell me they'll "keep an eye on" is my cholesterol, which in one month of weekly testings has risen steadily from 146 to 189. I'm wondering, will this drug-related increase will continue at the same rate or will taper off at some point? If the former, will I need to start taking cholesterol drugs too?

4) So far, I haven't missed a single dose of my once-a-day regimen, which I take around 11 p.m. every night. I have, however, varied my times slightly -- a few times at 10:30 (when I've wanted to go to be early!), sometime at 11:45 or midnight, and once at 1:30 a.m. Can I still claim perfect adherence, or is that amount of variation a deal breaker?

Thanks, D

Response from Dr. Wohl

Hi

1) Yes, the quicker the virus falls, the better.

2) The viral load can drop in stages: a rapid fall followed by a less steep decline and then an even slower decrease. It is hard to guess where your numbers will be, however, in one month. If the trend doen continues, I would not worry.

3) Total cholesterol can go up on the HIV medications you are taking but a significant portion of this may be a rise in HDL cholesterol (the 'good' cholesterol). I would not go crazy following this (weekly lipid testing is a bit much). See what happens after a few months. Also, be aware that diet and exercise can reduce bad lipids.]

4) My kingdom for a clinic full of patients as compulsive as you. You are doing great! Don't worry, an hour plus or minus should not be a problem.

Keep up the good work - DW



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