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To Stop or Stay With?
Apr 16, 2001

I have been HIV+ for over 9 years. I have been on Combivir and Viramune for the last year and a half. For the 7 years before treatment initiation and the short time since, my T4 cell count has been consistent between 600-900 with a good ratio 32-34. Before treatment, my viral load hovered around 6,000 and after went to undetectable on one test and 50-150 on the more precise. I have never had opportunistic infection or any of the other signs of disease progression. No night sweats, no thrush, nothing. My doctor says the treatment strategies have recently changed. Considering my stats before and after treatment, and weighing the risk of toxicity, he is recommending I discontinue treatment all together. If my stats begin to decline in the future, he says I can go back on my current regimen with equal success. What do you think?

Response from Dr. Young

Thanks for your question-

You've raised an increasingly common issue of when it might be safe to stop therapy. In general, I have not openly advised people to stop well tolerated treatments; however, it is also clear that as patients stay on treatments longer, that we will likely begin to see issues related to long-term side effects or toxicities.

What is clear is that when/if you stop, your viral load will return and CD4 count begin to decline; the main issue is at what time will restarting therapy be indicated.

We do know that if your viral load is undetectable at time of treatment interruption, that you are very unlikely to have drug resistant virus and therefore likely to respond to reinitation of the same regimen that you're currently taking.

I do adivse all persons considering stopping treatment to do so with close medical observation; we really do need to know how much and how quickly your CD4 count declines with time.

Hope that this helps, BY



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