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How long can Regimen last ?
Oct 12, 1999

I'm was diagnosed as positive in 4/99 after a seroconversion in 1/99 .... At the time my Viral Load was 97,000 and CD4 cout of 585.. Within thirty days of diagnosis I started a regimen of D4T/Viracept/Videx ... As of 9/99 My Viral load in undetectable and CD4 is up to 770 ..... I'm very good at taking my meds and have only missed a dose once... Can you tell me how often I should have my VL checked and at what point should I expect this regimen to fail if at all....

Thank you... JB

Response from Dr. Cohen

Hey JB - sounds like you've done well so far... and I don't think you need to expect failure.

If your viral load is below 50 copies on this triple - we would usually monitor it every 3 months or so. (if it was not below 50 copies yet it might still get there - it can take six months or so and you are just around month 6 now.) Those who are good at taking meds consistently have the most durable outcomes. And those who are below 50 copies and take meds as consistently as you have been are the ones whose viral loads stay suppressed month after month... and checking every three months allows us to look for surprises just in case. Including, for example, the possibility that you might get some future rebound due to some already resistant HIV from your initial exposure.

But your response to the meds suggests this won't happen. In fact, in a recent presentation from a study of a combination almost like yours - those whose viral loads were below 50 and who were good "pill takers" remained below 50 for the entire time on the study - there were no failures seen! How good do you have to be at pills to get that degree of success? Well, of course 100% is ideal, and missing one dose during a few months is close enough it appears. So it sounds like you are there and don't need to expect failure.

Oh, one more thing. You are doing great - but taking meds day after day after day can get tiresome it seems for some. And missing an occasional dose could happen in the future even if you are doing great now just from "adherence fatigue" setting in... If you note that happening - it would be VERY important to check in with your provider to talk it over - and see what can be done if that is the case.

We have reasons, based on the info we have, to not expect failure in your situation, but to expect long term success. Good luck.

CC



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