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LIFE WITH HIV
Apr 21, 2006

DEAR DOC

I AM 45 YR MALE WAS ADMITTED TO HOSPITAL IN NOV 2005 WITH FEVER/LOWPLATELLETS/LYMPH NODES ETC / AFTER A LOT OF TESTS I WAS DETECTED TO BE HIV POSITIVE

STARTED ON TENOFOVIR DISOPROXIL 300 MG/LAMIVUDINE 150 MG/EFAVIRENZ 600 MG MY VIRAL LOAD AT THAT TIME WAS ABOVE 100000 AND CD4 434

I GOT TESTED AGAIN IN FEB 2006 WITH VIRAL LOAD BELOW 20000 AND CD4 261

MY QUESTIONS ARE 1. IS MY MEDICINE REGIME GOOD OR BEST / CAN I GET ANY THING BETTER THAN THIS I CAN AFFORD ANY EXPENSIVE MEDICINE 2.WHY DID MY CD4 COUNT GOT DOWN OR AS SUSPECTED BY MY DOC HERE IN INDIA IT SEEMS TO BE A BAD LAB WORK INITIALLY AS HE SAYS IF MY CD4 WAS 424 AT THE TIME OF HOSPITALISATIONN THE CONDITION AT THAT TIME WOULD NOT HAD BEEN SO THADWITH HIGHER CD4 COUNTS SO IT WAS VERY LOW CD4 COUNTS AT THAT TIME /WRONG TESTING IN LAB AS DOUTED BY MY DOC 3. I DNT MISS MY MEDICINES AT ALL /GONE OFF SMOKING AND DRINKING COMPLETELY / EAT VEGETARIAN FOOD NO EGGS/FISH /MEAT . WHAT CAN I DO TO IMPROVE MY CD4 /IMMUNITY/AND HEALTH/ 4. WHAT DO U THINK IS MY LIFE EXPECTENCY AND WHAT WILL BE THE QUALITY OF LIFE AND HEALTH IF I KKEP ON TAKING REGULAR MEDICINES DO U THINK I CAN STILL BRECOME IMMUNE TO THESE MEDICINRES AND NEED TO CHANGE MY REGIMEN 4. WHAT ARE THE NEW DEVELOPMENTS FOR HIV TREATMENTS .DO U THINK I CAN EXPECT TO BE HIV NEGATIVE WITH NEW MEDICINES IN COMING YEARS

THANKS

Response from Dr. Daar

Thank you for posting your question.

I will try to tackle some of your questions, but first let me make a few generic comments. In general the response to effective therapy is a decrease in viral load of approximately 100-fold after 4 weeks and then to less than 500 by 12 weeks and usually undetectable using the assay that measures down to 50 or 75 copies/mL by 24 weeks. This may vary and you never want to make any big decisions regarding therapy based upon a single value, but they provide some guidance as to how one can assess an appropriate response to antiretroviral treatment.

Your regimen of tenofovir, lamivudine (3TC) and efavirenz is a state-of-the-art regimen that has been shown to have response rates in clinical trials that are as good as what has been seen with any regimen. I should note that your post says you are on lamivudine at "150 mg," the standard dose is 150 mg twice per day or 300 mg once daily. With that exception, I think you are on as good a regimen as money can buy. That doesn't mean it will necessarily be the right one for you, but it is a very appropriate place to start.

I would not worry about the single CD4 count going down as this number can vary. I would be more focused on your initial viral load response. Hopefully since the February results your labs have been repeated and you are able to better assess the quality of the initial response. If the viral load is not declining a resistance test should be performed if possible. Once the viral load is under control you can see where your CD4 count levels out. In most cases CD4 cells will gradually go up with time. Frankly, even if it didn't, with undetectable viral load and stable CD4 cells >200 or 300 cells/uL you are unlikely to become ill. Furthermore, it is my belief that those who get their viral loads to undetectable levels and take their medications consistently are unlikely to become "immune" or resistant to the medications.

Finally, with regarding to becoming HIV negative. I would be very optimistic that your viral load will become undetectable on therapy; however, you will likely always be HIV positive by the antibody test and will carry the virus in your body. In other words, a "cure" or viral "eradication" may not ever occur, but with current therapy you can control the disease, and I would hope be able to live a normal high quality life.

Best, Eric


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