How achievable is `below 50'?

How achievable is `below 50'?

AIDS Treatment Update, Issue 61-62, January-February 1998
Edward King

In the Merck 035 trial, only 60% of participants taking the triple combination of AZT/3TC/indinavir had viral load below 50 after one year of treatment. Dr Ian Williams of the Mortimer Market Centre notes that "people who are intent on achieving below 50 might therefore conclude that the risk of failure is too great with today's triple combinations". If your clinic is willing and can afford to prescribe the drugs, one approach might be to use four drugs. Alternatively, you might start with triple therapy and later modify your regimen if you fail to achieve below 50, or if your viral load increases after being `undetectable' with the new test.

However, Dr Mike Youle of the Royal Free Hospital is worried that this approach might mean that people would use up available drugs too quickly, limiting their long-term options.

He argues that reducing viral load from below 400 to below 50 may not make much difference to the long-term risk of developing resistance, because neither may be low enough. According to calculations by his colleague Dr Andrew Phillips, "based on what we know about the lifecycle of the virus and its mutation rate, you won't prevent the development of resistance in the long term unless you suppress viral load to 0.1 copies/ml. So in my view that makes the debate about 400 versus 50 copies is rather like debating whether you're going to buy a Ford Fiesta or a Mercedes, when your ultimate aim is to buy a Rolls Royce. The Fiesta may not last as long, but it may enable you to save up enough to buy a Rolls Royce later. However, if you live beyond your means and get a Merc now, the cost could prevent you from ever being able to get a Rolls at a later date."

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