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6 years of treatment
Jul 24, 2003

Hello friends, We are a couple from TURKEY, which is male negative and female positive. We learned that female positive at 1997 and we started to use AZT,3TC and Norvir at that time. After six months we made all tests and CD4 was 800 VL is undetectable. We finished to use Norvir and continue the treatment with AZT and 3TC. We made tests several times and always CD4 around 800 and VL is undetectable. LAst week we made all tests again and result is same. Of course we are very happy about it. So, almost 5,5 yrs of dual therapy was enough to keep it. What is your suggetions after that moment. We would like to have a baby but we are very confused. Thank you for your helps.

Response from Dr. Boyle

That's not an easy question to answer. While triple therapy is clearly superior to dual therapy, studies do indicate that some patients can continue to maintain undetectable viral loads and stable immunologic function on dual therapy. Another possibility of course is that of long-term nonprogession (LTNP), and that is tough to judge given the lack of information about the baseline CD4 and viral load. I have a few patients who continue on dual therapy (started many years ago), despite my urging them to change to more intense regimens, and for the most part they have done well. So, I would say this is one of personal choice. Given the long-term success, I think it is reasonable to continue on dual theapy with careful monitoring, but intensification is reasonable as well, but if you opted for intensification, I would probably wait until after the first trimester to intensify so long as the viral load remained undetectable. Since LTNP is possible, you might also consider interrupting therapy with careful monitoring, either before or after the pregnancy.

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