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New HIV+, Vaccines, Viral Load, AZT/3TC

Jan 13, 1997

First, thank you so much for providing a non-judgemental, un-hurried forum for questions about this life-threatening illness. 1) I have recently tested HIV+ and have t-cell count of 398 & viral load of 125,000. I tested + for hepatitis b virus, not antibodies, also. 2) My doctor wants to start me on AZT, 3TC combo for one month and then add indinavir. He wants to see effeciveness of & my compliance to the regimen, before giving indinavir. I understand & agree with this. I am to be given vaccines for flu, pneumoccal pneumonia, a tb skin test, and hepatitis b this week. Vaccination I read raise the viral load for 4-6weeks, while at the same time the AZT/3TC combo is supposed to lower the viral load within 4-12 weeks. My question is this: Should I ask my doctor about this seeming conflict? How can we monitor viral load and determine effectiveness of a regimen while adding the vaccinations which typically raise the viral load temporarily. I don't want to seem to question his judgement on this, but I'm not clear on how this should work. Any advice you could give would be helpful. Thank you again.

Response from Dr. Cohen

It may be true that vaccination causes a brief rise in viral load, though not all studies show that. It's probable, however, that if you get vaccinated while taking effective antiretroviral therapy (like what you'll be taking), any increase would be blunted or completely blocked. Furthermore, we know that vaccines work better in people with higher CD4 counts. Therefore, when I have a new patient who needs both antiretroviral therapy and vaccines, I usually wait until he's been on the antiretrovirals for a few weeks before giving the vaccines. That way, any increase in viral load will be minimized, and the vaccine will be more likely to "take" (form antibodies).

You said you "tested + for hepatitis B virus, not antibodies." I assume you mean that you have the antigen (HBsAg or "surface antigen.") If so, you don't need the hepatitis B vaccine because it's too late to prevent hepatitis B.

One more thing. It's getting pretty late in the year for a flu shot. The optimal time is in the fall. By mid-January if the flu hasn't already hit your community it will soon, and so there's not time to develop an immune response to the flu vaccine.

Undetectable virus with CD4 drop!
Necessity to do Viral Loads before Rxing a Protease Inhibitor

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