Hi Dr. Daar,

I wrote you about 6 weeks ago (message titled, Still detectable after 8 months) A quick review at that time: Tested positive 8/24/05 Sept 2005 CD4=350 (25%), VL=98,559 Nov 2005 CD4=288 (18%), VL=43,299 Dec 2005 -- Started on Sustiva/Truvada (first HIV meds ever) Feb 2006 CD4=521 (27.4%), VL=539 Apr 2006 CD4=499 (31.2%), VL=643 June 2006 Added boosted Reyataz to intensify my regimen Aug 2006 CD4=576 (30.3%), VL=111

I had resistance testing done in Nov 2005 and repeated in May 2006. Both results were the same: NRTI mutations- 41L, 208Y, 211K, 215S NNRTI mutations NONE PI mutations 36I, 63P, 93L

My latest results are in (drawn 9/19): CD4=622 (29.6%), VL=163

So, the UD result still eludes me, as everything was basically unchanged. My bili went up to 3.4 and my chol was slightly higher (Im on Lipitor), also my Triglycerides doubled to 184, but all in all, not bad. Should point out that I was getting over a herpes outbreak the week before my draw I have to laugh at the unfortunate timing first outbreak since I started on meds last December.

I suppose I could consider changing PIs to one that isnt lowered due to both Sustiva and Truvada, but Im hesitant to start mixing things up and exposing my virus to more and more drugs. Perhaps Im just someone who will take a long time to get <50, if I ever do. I mean not that long ago Id be thinking things were fine when the VL assay had a lower limit of 400. My ID doc and I have decided to leave things as is (well, switching to Atripla in Dec) and check my labs again in December (well, we will repeat my TBili in Nov)

Do you have any thoughts, suggestions on next steps?

As always, Thanks for all you do here, Mike

Hi Mike, I certainly agree that waiting a little longer is okay. I would suggest that if your viral load remains detectable on the next two measurements, separate from any other medical problems such as herpes, that you do consider switching your regimen to an alternative boosted PI. That being said, I remain optimistic that what you are on should work if you are taking your medications consistently. I would actually think the NRTIs plus boosted PI without the NNRTI should be highly effective. I also encourage you to talk to your provider about whether you are on any other medications that could interact with your HIV meds.

Best, Eric