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initial treatment, high viral load
Nov 6, 2000

I am planning my INITIAL treatment.

My viral load is "greater than 750,000", which means it could be 2,000,000, right? My CD4+ count is 86.

So the regimen I am thinking of is:

1) Videx CHW 200MG

2) Zerit Cap 40MG

3) ABT

What are your thoughts/comments/questions I should ask???

Response from Dr. Cohen

Not exactly sure but I am guessing that by ABT you mean kaletra or ABT 378/r? This is the newest protease inhibitor -- that is actually a low dose of ritonavir in the same capsule as a new PI called lopinavir -- and it is actually only the lopinavir, boosted by ritonavir, that is the active drug.

But the combination of three meds -- in this case one protease inhibitors and two nucleosides -- have often been shown to be successful. The combo of these two nucleosides -- zerit and videx -- and this PI has not yet been formally studied but should work as well as other similar triples -- and they have worked very well so far. Even at very high viral loads. And yes, your viral load could be anywhere over 750 thousand. Could be 755 thousand. Or two million. Can't tell from that test, nor is there too much reason to break it down, since high is high. Fortunately, combos based on ABT 378/r and two "nukes" have been very potent even at high viral loads. And it should be potent even at CD4 counts below 100, like yours.

A few points. Videx is now available in some countries including the USA as a capsule instead of the chewable wafers. This may make it easier to take, and those who have switched have mostly reported that it is much easier to do. With less diarrhea. There are some switch studies going on here in the Boston area, and others can now consider the switch since the drug has been approved here in the US as well. However keep in mind that Videx needs to be taken on an empty stomach, while ABT needs food to be absorbed. So you'll need to take meds three different times per day -- ABT 378/r with food twice a day, and Videx on an empty stomach. (the zerit is taken with the ABT 378/r).

Hope that helps.

CC

Cal Cohen, M.D., M.S.



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