I have been hiv+ for 15 years now and have taken many of the meds out there today. Today, I am on reyataz, epivir, norvir and viread with t-4's at 500 and viral load around 25,000. Since I am resistant to most meds out there today and I don't qualify for the CCR5 studies since my biliruben is too high, my feeling is to stick with my current treatment until viral load peaks at 100,000 or t-4's drop below 300 and then make another drug switch. What are my options?

Without more specific information about your previous treatment history and drug resistance pattern, both now and in the past, I can not make specific recommendations. However, I can make some general comments regarding your situation.

First of all, I assume that you have had low T cells in the past that require you remain on therapy. For example, if your T cells have never been lower than 350 (for example) cells/uL, even prior to starting therapy some consideration could be given to being watched off treatment. Again, this should only be considered if you have never had low T cells, and even then with very close observation by your primary provider. If stopping is not an option, which it usually isn't, other issues must be considered.

Clearly the good news is that you are immunologically in good shape with T cells at 500 cells/uL. What needs to be done now is to assess whether you have treatment options that you could tolerate and may result in viral suppression to below the limits of detection. The goal would be to see if you and your provider could review your medical history and identify 2-3 fully active agents, often including a ritonavir-boosted protease inhibitor, possibly several NRTIs, and perhaps T-20. If you have not been on NNRTIs (such as Sustiva) in the past this might also be a part of such a regimen. In any event, if such a regimen can be created I would recommend strongly considering using it now before you develop more protease and NRTI resistance that might limit your options when you really need them, when your T cells start to decline. If you and your provider determine that full viral suppression is not possible at this time, either because of drug intolerance or resistance, your strategy of maintaining immunologic stability on your current regimen while you await new options may be very reasonable.

In order to provide more specific information related to your case I would need considerably more information. I suggest you raise the general issues discussed above with your provider and go from there.

Best, Eric