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Week 12 and counting...
Feb 10, 1999

Hello Dr Cohen:

I tested positive 9/98 and place exposure in early 1998. My initial blood workup was done on 10/7/98 and came back at VL of 134,420 and CD4 of 254 (17.5%). I began a PI sparing regimen consisting of Epivir, Zerit and Sustiva on 10/10/98, have taken all doses religiously and seem to have responded well with no unusual reactions or complications. Subsequent blood analysis was done on 10/27/98: VL=3,617 and CD4=329 (18.5%); 11/30/98: VL=804 and CD4=409 (23.5%) and 1/27/99: VL=336 and CD4=541 (27.5%).

I have seen your answers repeatedly advise that successful regimens will get the viral load below 400 copies by around week 12 and below 50 copies by around week 24 and keep it there. I have also seen your replies that it may take those with viral loads starting above 100,000 longer to get there with a somewhat lower chance of success. So far my numbers continue to go in the right direction and I have made it to the week 12 hurdle but am interested in what you think of my results. And, looking towards the next few weeks, what are my best options and how long should I wait if week 24 comes and the viral load is still above 50?

Thanks in advance for your opinion, assistance and all your thorough and upbeat answers!

Response from Dr. Cohen

thanks for your comments as well.

You are responding just as you should - your viral load is below 400 at 12 weeks, and your T4 count is growing quite nicely - it has doubled in that time as well, which is mighty impressive and is better than average - which speaks to your immune reserve perhaps. Your dedication to this pretty simple combination is one key to its success. And even though you started above 100,000 - your response is as good as those with lower loads- another good sign. The only part of your story that is a bit surprising is your initial T4 count despite your estimated exposure of about a year or so. But it can happen that those just recently exposed will have a count that low in the first year. It may explain how your immune system was able to double in such a short time.

So what to do is just more of the same - it sounds like you are already getting the 'ultrasensitive' viral load test since you reported a level below 400 copies. I would suggest just rechecking - certainly at week 24, though sooner is OK too. Your viral load is very likely to just keep dropping, and your early response would allow us to predict what will likely happen between now and week 24. But some like to watch. And if you want to watch it fall off, that is OK too. The main advantage of more frequent checks is just in case of surprises - to catch them sooner. But there is virtually no good reason to expect a surprise given what you report so far: Faithful dosing. A potent regimen. And evidence that you are responding like those who are successful.

I will be presenting information of a study which used this combination in about 70 people at a meeting in Germany in about a month - I don't have the results yet, but based on similar combinations, this is one of the best yet.

good luck with it. CC



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