MY VIRAL LOAD 6 MOMTHS AGO WAS 300 NOW 6 MONTHS LATER IT IS 565. iT WAS ALWAYS UNDECTABLE. i STARTED PROTEASE INHIBITORS 1996. nOW I AM 56 AND HAVE BEEN ON EPZICOM AND VIREAD FOR A NUMBER OF YEARS. wHAT MEDICATIONS DO YOU SUGGEST FOR ME AT THIS TIME? i JUST TOOK A PHELNO TYPE TEST. sTARTING TO WORRY AGAIN AFTER FEELING VERY RELAXED. mY T CELL COUNT IS 1200 ALWYS HAS BEEN HIGH. OF COURSE MY DOC SAYS IT'S ALRIGHT BUT I NEED MORE ASSURANCE AGAIN. tHANKS FOR YOUR OPINION AND ADVISE.

I can also reassure you that you are Ok now because your CD4 count is very good. You are taking the right steps to be on top of this recent increase in viral load. Since it was confirmed and you have been adherent it seems that you will need to intensify your treatment regimen. The regimen you are on of epzicom and viread (alone?) would not be considered a strong enough treatment to keep your virus suppressed long-term. If you are still on a protease as well, is it with or without ritonavir? "Boosting" the protease inhibitor (other than nelfinavir) by giving it with ritonavir can increase the blood level and make the drug more effective. The phenotype now may or may not yield results since your viral load is so low. Your next choice of treatment is going to depend on how much prior resistance your virus has built up over the years. Since you have been undetectable for years that should protect against significant resistance having built up. With boosting of a protease (if you are not already) and the availability of other classes of treatment (NNRTIs, Integrase and Entry Inhibitors) it should be possible to contruct a regimen for you with 3 active drugs. Also, since your viral load is still quite low that will make it easier to suppress.

Good luck,

Joe