Question
Is my new combination a good choice?
9 October 2008. Related: All topics, Changing treatment.
Hi
Hopefully you can help me with this decision! I have been on Truvada/Sustiva for 4 months seeing my viral load drop from over 1 million to 168 and my CD4 climb from 208 to 810. My last set of results received today have seen my viral load rise to just 199 but CD4 has remained the same! My doctor thinks that Sustiva is not agreeing with me as I am tired/anxious all the time and has switched me to Truvada/Atazanavir/Ritonivir. I am concerned, as I have never reached undetectable yet, but everything was going well and was refused a blood test today to see if the result was just a blip as he said this is only going to panic everyone?
I was also told that another option for me is to stop treatment altogether as my CD4 is so high???
I am so upset by this and don’t know where to turn. Can you please help in answering this as soon as possible.
Surely this is all conflicting information and bound to confuse me? I was told by my consultant that I am seeking advise from too many sources and I should just trust him and the nurses, so I am even unsure if you are able to comment.They forget this is my life and surely these are my choices to make, once I have received all the information I feel I need in order to make my decision.
Answer
Firstly, let me say that I completely support your line of thinking. You are the one who is responsible for your decisions and the times are gone when a doctor could just say ‘Take these pills and you’ll be fine’.
You are right to find out about your treatment, and it can be confusing when you realise that there are several optioons for any situation. Treatment is very individual and sometimes it takes a few changes to find the best treatment for you.
Your doctor is giving you god advice in changing treatment because you were having side effects from your first treatment. The change is also likely to help get your viral load to undetectable in your next set of tests.
Sometimes treatment is used for a short period (say 6 months), in people who are recently infected, if seroconversion causes a CD4 drop to below 200, in order to help bring them back to the margin where developing opportunistic infections is unlikely. Many people make this choice and have several years without medications. In your case, the CD4 count is really OK to do this, if you decide.
As for the current combination, many doctors prefer to use a PI when the VL is detectable even if low, as this reduces the chances of developing resistance to NNRTIs. The PIs are more robust. You use ritonavir now though and will have to be careful for possible drug interactions with other medications you may take.
Hope this helps!
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