Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Switching meds?

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FiercenBed:
im @ cd4 347 28.9 and vl 489 truvada & kaletra since july. doc finally had the balls to say ' the treatment is failing'. hez bn saying everything is 'fine' past couple months and not to worry. now he sez i should have definitely bn undetectable by now. he sez it is going to be hard to do a resistance test w/ the viral load so low. also if u stay on a failing treatment it increases the virus's ability to develop resistance for other drugs. I DO NOT WANT TO CHANGE MEDS! the 2 month acclamation period was total hell. u name the side effect and I had it to the point of suicidal. Im still having some side effects but i can deal w/ them. im gaining weight and feeling 'ok' day by day.

anyway....my question is if or moreinlikly when i change meds am i going to have to go through the acclimation period all over again? or now that my body is adjusted to meds will it be a minor change?

thanx for the input!

gerry:
I would not necessarily say that your treatment is failing.  It may just be taking a bit longer to get you to undetectable.  You started with a VL of 150000 and went down to 5000 in 1 month which is a pretty good response.  Your current VL is still within reasonable range of a fairly good response after 4 months.  The DHHS guidelines define incomplete virologic response as VL staying above 400 after 24 weeks of treatment.  Your current numbers, if I am not mistaken, were obtained at around week 16 or 17.  So you are still within striking distance of complete response.  This is assuming of course that you had baseline resistance testing which showed no resistance to the current meds you are taking.

Here's the definition of treatment failure from the DHHS guidelines:

"Virologic Failure can be defined as incomplete or lack of HIV RNA response to antiretroviral therapy:

Incomplete virologic response: This can be defined as repeated HIV RNA >400 copies/mL after 24 weeks or >50 copies/mL by 48 weeks in a treatment nave patient initiating therapy. Baseline HIV RNA may impact the time course of response and some patients will take longer than others to suppress HIV RNA levels. The timing, pattern, and/or slope of HIV RNA decrease may predict ultimate virologic response. For example, most patients with an adequate virologic response at 24 weeks had at least a 1 log10 copies/mL HIV RNA decrease at 1-4 weeks after starting therapy.

Virologic rebound: After virologic suppression, repeated detection of HIV RNA."

newt:
Hello

What Gerry said

Plus a viral load of near 500 is high enough to do a resistance test with the latest generation of test, if they can't find enough virus to make the test work then you's probably on your way to undetectable.

PI based combos take longer to suppress HIV to undetectable levels than NNRTI (Sustiva etc) combos.  Me, on a PI, but different one, took 8 months.  Viral load tests do not produce exact numbers, there's some margin of error, tis possible you are in fact (well) below 400 copies already (er, but also above...soz). Given your very good initial response I'd wait n see, at least til 24 weeks.

Adherence is important, and sharpening your timing if this is a bit wonky may get the extra few virons knocked off the count.

Plus if you's doing Kaletra 1 x day, doing it 2 x day may also help (cos it will even out the dose and avoid a possible but difficult to measure drop to an ineffective level at the end of each 24 hours).

- matt

FiercenBed:
update....vl results today.......3,822

i guess we can deffinitly call that a vl failure. great way to start off the holiday

happy thanksgiving  :-[

allopathicholistic:

--- Quote from: FiercenBed on November 22, 2006, 07:02:13 PM ---update....vl results today.......3,822

i guess we can deffinitly call that a vl failure. great way to start off the holiday

happy thanksgiving  :-[

--- End quote ---

Fierce: Please tell us exactly what you were told so we can best help you. Be strong honey

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