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Next Treatment??!!
Sep 29, 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. Lee

A viral load of 121 one time is not necessarily significant, having it rechecked is a good idea. You didn't give a good description of the resistance you have developed, although you have listed resistance to the following:

Nucleosides: AZT, DDC, 3TC, DDI, D4T Non-nucleosides: no resistance Protease Inhibitors: Saquinavir (and Fortavase)

After two years of well-controlled viral load on a non-nuc (Sustiva), PI (Kaletra), and two nucs (Viread and 3TC or Epivir). If your VL continues to increase, you might consider adding another nuc such as Ziagen (abacavir) to strengthen this regimen.

AS far as how high should you go before adding or changing your regimen- it depends on how aggressive you believe you should be. Personally, I suggest a very aggressive stance, but talk this over with your doctor.

Be well.



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