Question

I have recently started on HIV meds Sustiva / Truvada. My VL went from 220,000 down to 153 in 5 months and my CD4 count from 704 to 880. I am worried that I'm not going to be completely undetectable. I have not missed even one dose yet? Am I gonna fail? About how long before I should start to see myself fall to AIDS level of 200 count CD4? They are also considering starting me on a PI to bring my VL down to below 50. Is this wise?

Answer

It's great that you have not missed a single dose - keep it up!

It often takes more than 5 months to become undetectable. Its more likely when the baseline viral load is over 100,000, as in your case. All other measures suggest that you are having a positive response to the regimen, so I suggest that you be patient and continue your excellent record of adherence.

It would be reasonable to consider an alternative regimen if you remain viremic, or if there is evidence of a loss of response - but not at this time. If a change is made, then the use of a PI-based regimen would be reasonable.

The average loss of CD4 cells in a person without ART is around 100 cells/year. It is likely that you have some time before reaching a level of 200 CD4 cells.

I suggest you talk to your doctor about these issues, and about your concerns.