Question

I have been diagnosed positive in Apirl. I am sure that I was infected in Dec.2010. My CD4 droped to 310, VL 240,000 in May. My doc started the treatment with AZT, 3TC & Efavirenz. I have been on meds for 1 week so far. Am I regarded as the fast progression group & what does that mean for a long term? Is that common to have that huge viral load? Is it ok to start treatment without a virus resitance test & how possible my virus is resistant to the drugs since the VL is really high when I started. Really appreciate your help... Thanks!

Answer

Hello and thanks for your post.

A viral load that's greater than 100,000 is generally called high-- your's is high, but I wouldn't call it huge. We occasionally will see viral loads in excess of 1,000,000 copies.

Nevertheless, persons with high viral loads tend to have more rapid decline in CD4 counts; perhaps explaining why your count is 310 only after a few months of suspected infection. Nonetheless, current treatments are very effective in suppressing virus, even in high viral load patients- so I don't think that this should be a harbinger of a bad long-term prognosis.

I do have a question about your doctor's choice in medications. While AZT+3TC was the industry standard for many years, we have several better tolerated NTI combinations that are recommended in the North American and European treatment guidelines (namely tenofovir+FTC or abacavir+3TC). Efavirenz (Sustiva, Stocrin) is an excellent well-studied and highly recommended component of treatment, so I've got no issues with it's selection.

In general, current treatment guidelines recommend waiting to start treatment until drug resistance testing is obtained. This is because approximately 10% of newly infected, treatment-naive persons harbor virus with some evidence of resistance; most commonly to the NNRTI class of medications (like efavirenz). Transmitted resistance to one medication in a regimen could weaken the entire regimen and risk further drug resistance. Additionally, since your CD4 count was 310, you were in no imminent danger of AIDS complication, so waiting the roughly 10-14 days to get a resistance test result wouldn't jeopardize your health in any significant way. Absent a resistance test, you (as always) should strive for maximum adherence to your treatment and your doctor should be monitoring your clinical and laboratory progress as closely as possible.

I hope this helps. Feel free to write us back on the forum at any time. Be well. BY