Thank you for answering my question. I did take how you responded into consideration, but continued as before. I just wanted to give you a follow up on my status. Labs came back great! Still doing every other day of my meds. (I take all meds together). Has been at least 10 months of following this regimen. Still undetectable, CD4-419 highest ever since diagnosed. I knew it had to be good because I also feel the best I've felt in 10 years since diagnoses. My doctor recommends to continue current regimen and even offered that I could come every 6 months for check-ups. I'm sticking with every 4 months for right now, if this current drug regimen should fail (think it would have by now if it would) I want to know right away. BTW when diagnosed I had 90 CD4, viral load >100,000, had PCP and almost died, just wanted to put this in perspective. I fully respect the meds, I know I would have died had I not had them. My only thinking is that as a country we overmedicate many conditions and if a condition can be treated with 1/2 the meds at 1/2 the cost and 1/2 the toxicity, why not? I'm surprised that this hasn't been studied yet? Any thoughts?

I am glad that you are doing well, and if it ain't broke don't, fix it. People do metabolize medications at different rates, but doctors dose HIV drugs as if "one size fits all," which is clearly not the best way, especially if someone has side effects. That being said, the principles of treatment are also very well established, and we always try to have the best outcome for all people. Even if 6 or 8 out of 10 people could have success with an alternative dose, it may be difficult to know who those people would be in advance, and we would not want to risk having a poor outcome for the 2 to 4 that would not respond.

Dosing of meds is based on the way drugs are metabolized and the clearance of meds from the body. These are determined based on computer modeling and trials in animals and humans. The dose has to be established to provide the safest range, so that most people will have the benefit of the meds with the lowest risk of toxicity. Only then can large clinical trials be done to see how well the medication works. Once that dose is established we have to see how a specific individual will do on the med and dose adjustments may be needed. Measuring blood levels (therapeutic drug monitoring) has had mixed results since we often do not know how much medication in the blood is enough to counteract a particular person's virus. In general, advising use of the standard dose is the best place to start.

Good luck for continued success.

joe