Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Dear Dr.,
Well, I am William, 39 years old, and I have been detected as being HIV
positive on September 1997. A complete year I had no need to take
pills because of my normal CD4 counts and an undetectable viral
load .Since October 1998, when my viral charge increased to 2000
copies/mL, I was prescribed with AZT (600 mg a day) and DDI (400
mg a day). This regime has not suffered any change at all until
present and my viral load has maintained as non detectable (with
the current laboratory test with a sensibity of 50 copies/mL) and
my last CD4 count was 961.
My doc suggested to continue with the same treatment because the good results and the normal hepatic reponse to the drugs. I would like to know what would be your procedure in a case like this one based on the knowledge that is been elucidating from the last research and statistics studies?
Thanking you in advance
To be clear right from the first moment: your doctor is right/do not change your regimen. We have a saying in the US, "if it ain't broke, don't fix it". What this vernacular phrase means is that nothing is wrong, so don't interfere.
To elaborate, it appears that you are very fortunate in that your immune system has been very successful in controlling HIV all on its own. Your viral load was very low right from the start, and has now been controlled with a regimen of two drugs only.
Now, to contradict what I say in the opening, you may want to stop your two drug regimen. Current treatment guidelines say that HIV treatment does not need to begin until tcells are below 350 (Europe say down to 200) and/or viral load over 100,000. Clearly you don't fit either criterion. Many physicians are now taking patients like you off meds, and watching where the tcells and viral loads end up. And if the tcells and viral loads are not at the level currently accepted as the indication for starting therapy, the patient is simply followed with blood work every 3 months.
So now there are two "right" decisions. You can stay where you are. Easy regimen, undetectable viral load and normal liver enzymes. Or you can stop the meds, watch the labs and see if you can possibly go years before needed to restart meds.
I would suggest you have another discussion with you doctor about these two options.
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