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Kaletra & Kivexa, Slow response?
Sep 15, 2007

Hi, my husband was diagnosed with AIDS in Jan. 2007. He had a viral load of 1000,000 per ml and a CD count of 30. He started HAART in early March 2007 on Kaletra first then had Kivexa introduced in May. His CD count jumped significantly when he was in hospital to 175 then his next test showed a CD count of 75 then a viral load of 1000 recently his count is 100 with a viral load of 70. I love my husband very much and God has been very good to me - I somehow have remained negative and have given birth to a son also negative. I want my husband to live a long life. He is troubled by peripheral neuropathy in his feet and gets colds often but gets a nebuliser occassionally to stop him getting chest infections. Do you think there is anything else his Doctor can do to increase his counts and make him undetectable? Is it unreal to expect him to be undetectable already? I know CD counts take years to increase and he did go into hospital with PCP. But are there better meds my husband should be taking? I know when he was in hospital there were many complications with his kidneyy and liver but these have normalised. Now his cholestorol is 13 (high)and he has gained a lot of weight. My significant other is only 27 and his life has always been crap until we married now this! I want to give him many happy memories and we are working with the Repro to have another baby via IVF. I just want him to be free from great risk of infections and illnesses related to the Virus. I am sick with worry and it is starting to affect my mental health.

Response from Dr. Daar

Thank you for your posting.

I will try to address some of the issues you raise regarding your husband. First of all, I would suggest that it is a little too early to give up on him getting to undetectable viral load. From what you say it sounds like he started with a high viral load and has only been on his current regimen since May. In general, it is anticipated that someone like him should be undetectable within approximately 6 months of starting therapy. He is still well within this window period and it sounds like he is very close to achieving this goal (last viral load of 70 copies/mL). I would sit tight with close follow-up for now.

You are correct that CD4 cell counts can take a while to rebound in some people. It is worth talking to his doctor to make sure he is not taking any other medications that could be reducing the absolute numbers but most of the time I encourage patience in this situation. The good news is that despite the number of CD4 cells, most patients with undetectable viral loads continue to remain very healthy.

His complaint of peripherap neuropathy is concerning. It is important to note that none of the HIV medications he is taking are likely to be contributing to this problem. In fact, if his neuropathy is related to HIV the current treatment might even help. There are many other causes of peripheral neuropathy that should be explored with his provider, including other drugs, vitamin deficiencies and diabetes. There are also treatments that provide relief that could be considered.

I hope this helps. Best to you and your husband.

Eric


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