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How long can i stay like this
Jul 6, 2003

DOCTOR COHEN,

I have an undetectabke viral load and a t-cell count in normal ramge. I never miss my pills and i have a steady system of taking them. But i stay up all night worrying about my combo, how long can it keep me well?

Response from Dr. Cohen

With perfect adherence, and a combination that is working - meaning that for however long it has been, your viral load is very suppressed to "undetectable" levels - for a good long time - there is very very encouraging news. Those in this fortunate category are doing great month after month, year after year. We no longer think of drug failure, and virus resistance as inevitable. It is more likely these days to think of success as a very reasonable expectation once someone like yourself gets there on a combo they feel well on, and stay with, with continued successful lab tests.

So what can go wrong? The biggest concern many in the field have these days is not viral escape - if it has not done so after a good long time, it may never figure out how to ignore the meds you are now on. What we do worry about is the side effects that may happen to those taking our meds year after year.... while some are fortunate and not seeing problems, others are seeing cumulative concerns. Meaning the longer you are on meds, the more things seem to be going a bit off... like changes in body fat distribution. Like abnormal blood sugar tests, abnormal blood cholesterol tests, abnormal liver tests, and so on. And while we have options to change to - and we do - we can sometimes have trouble maintaining control of HIV while finding a combination that has the fewest long term side effects. Not impossible - but it can get challenging.

We also can rarely see surprises - perhaps an illness that causes your body to not absorb the meds well enough for some period of time and this leads to low drug levels and virus escape. But it does seem that there is a "cushion" once suppression is achieved - meaning people can miss a rare dose and not see virus escape - so you need not fear if you've been successful all this time...

So keep it up and keep checking - we don't want to just assume it, but prove it over and over. Remember - even your clincian enjoys seeing succesful lab tests...

OK?



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