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Halt Immune Deterioration awaiting Resistance Test
May 5, 2008

I have been on ART for the last ten years and in July 2007 switched from use (after 8 years) of Crixivan and Combivir to Alluvia and Truvada. My CD4 count was 486 at the switch but has since declined to 52 in February 2008. My viral load has increased from 32,000 copies to 230,000. My doctor suspects possible drug resistance and asked for one to be done. Unfortunately, resistance tests here takes almost 16 weeks which I fear may be too long, given the rapid change in my CD4 count and increase in viral load, and I have sufferred a persistent cough and cold. Is there a temporary fix that can stem the possibility of a rapid degeneration?

Response from Dr. McGowan

Ideally, a drug resistant test would better guide your provider as to what regimen you should go on next since there is no doubt that you would likely benefit from HIV medications given your CD4 count of 52. There are newer therapies available to treat virus that is multi-drug resistant. It would be best to construct the optimal regimen based on resistance test results. Treatment regimens can be constructed without resistance testing based on assumptions of likely resistance patterns, but these regimens are often highly complex ("mega-HAART") and may include less active drugs, generate unnecessary drug interactions and potential toxicity. If availability of resistance testing where you live is so limited I am concerned about your access to these newer therapeutic agents as well. If so, enrollment in a clinical trial, if available, may make access to newer agents possible. While you are waiting for your result, it would be important for you to be on recommended prophylaxis medications to prevent opportunistic infections, and to see your doctor so that your persistent cough and cold can be evaluated. If you have developed an opportunistic infection it may also be contributing to your rapid viral load increase and drop in CD4 count.

I hope you respond well to your new regimen.

Best,

Joe


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