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wait or go for it????
Nov 13, 2001

DR. Cohen, i have ask you questions before and it has been very helpful. Thank you. I have another, my t-cells have been in single digits for 2 years now, recently I have gained around 3lbs. every 6 weeks or so.. My viral load was 354 in August and am awaiting results from one drawn last week.....I have been trying to get tenofivir for months (my physician refused to be in the study) Now that it is aprroved I ask for the prescription for, but he thinks i need to "save" it because my viral loads have been inproving, my t-cells have been 4, 9, and last one was 16......Should I "save" tenofivir or go for it????I am resistant to most of the meds avalible. I have not been sick yet, the only opp.inf. that I have had is thrush.....I would appreciated any suggestions that you can give me.....I am taking kaletra, zerit, agenerase, diflucan, and dapsone.

Response from Dr. Cohen

Well, to summarize your situation - your viral load is just under 400 copies, but not below 50 - and your CD4 counts are very low. And you have lotsa resistance to other meds. And now with tenofovir here- the question is what to do with it?

We have learned from past experience that those whose viral loads are less than 50 copies seem to have a much longer response from these meds. The virus stays quiet and controlled far longer. And this is especially important for those who are playing the few remaining cards in the deck - since if this doesn't work... there may not be too many newer options in the near future to rescue these. And the best way we know to increase the Cd4 count from this low level is to stop HIV as well as we can.

So - I am not sure what your provider is saving tenofovir for... For example - there is a very small expanded access program just announced to provide a few people with the drug called T20. But, at least for the near future - this is the only expanded access coming out. And there are trials of other newer meds coming as well in these next few months. And we have learned that when we start two new meds - like tenofovir AND something else - the benefit lasts far longer that when we use meds one at a time. So perhaps that is the strategy here...

But on the other hand - your viral load is already pretty low, and you are pretty close to this threshold of getting almost complete suppression. And if tenofovir is active for you, it could ever better suppress HIV now. And do so with this combo, and help these meds last longer. And increase your T4 count now, when you need it. Which could help.

So, unless there is a plan to start you on two new meds, one of which is tenofovir - it seems that starting it now would be a very attractive option - to preserve the benefit of the meds you are now on. Which hopefully will last as long as you need them to...

Hope that helps.



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