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Should I be on drugs?

May 19, 2000

I have been positive for 11 years. I started taking azt by itself in 1993 and later added 3tc in 1995. My viral load has always been between 2k and 10k and my cd4 between 500-700. My doctor has always wanted me to get on a new combination which included a PI. I have held off from doing that because I am asymptomatic and have never had any problems. Three months ago I decided that my body needed a break after taking azt for 7 years and 3tc for five years. My results just came back. CD4 -- 570 and VL 8K. This is within the normal range I have been seeing over the years. I don't think the drugs were doing me any good so should I just watch it real closely or make some changes? Thanks

Response from Dr. Cohen

Well, it sounds like you have already decided to take a break, and it would be hard for me to talk you out of that now if your numbers are the same and you feel fine! So I'm not going to do that. Careful monitoring at this point could be a reasonable choice, probably the best one unless you are committed to the process of starting all new drugs. Which you aren't right now....right?

With your numbers where they are (pretty good), the risk of any serious HIV-related complications in the next year or so is pretty small. It would be smaller it you were on

HAART, but it is still pretty low. Off therapy, it is likely that your viral load will go higher than now, but when is hard to say. It is also possible that your CD4+ count could drop sooner... You should certainly have close monitoring in the next few months, to see where the numbers go. If they get worse, you should consider a new combination, with all new drugs. And in the future, you should have resistance testing (geno or pheno) done for any detectable viral load, before you stop the drugs. This could help plan your next regimen.. probably not helpful now since you have been off drugs for 3 months.

If the numbers do change for the worse, the good news is that you have excellent choices since you've only used two drugs. Also, you will probably feel more committed to therapy at that time, if that happens. And ultimately, that should improve your long-term "compliance", a good thing.

Hope this is a perspective that is useful. The bottom line is that you should be really committed to follow-through on the next set of drugs. If you aren't sure, get the information you need before you start. Good luck!

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