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What Causes Drop In Cd4 After Taking Duovir-N?
Question: Hello Doctor ,
My wife , age 36 is a HIV positive patient . She is currently taking Duovir - N ( Lamivudine, Zidovudine and Nevirapine ) . Please refer to the attachment ‘moni.pdf’ ,
She started taking Nevilast-30( Lamivudine, Nevirapine and Stavudine ) from apr 2007. Somewhere in July 2008 she discontinued the medicine( due to misguidance) and restarted in dec2008 . and then on she was fine , did not have problems. ( CD4=900 , Viral load >20)
We started consulting a very good doctor from 2012 onwards. He was suggesting that stavudine has very strong side effects. ( like uneven fat distribution) In fact her face had very slight muscle loss and hands& legs had become slightly thin. Our doctor suggested a regime change.
So she started taking duovir-N from Aug 2013. From that time onward her cd4 started to go down. My questions are
1. Please let me know if the drop in cd4 is because of drug resistance or because of regime change. Is there a way to find out ? ( I’ve all the reports).
2. If this is drug resistance , she will have to go for second line treatment , On an average How much time will the second line treatment can last ( approx in years).
3. Is 3rd line treatment available in XXXXXXX If yes , in which cities. ,
if no is which countries have this treatment? Is it very expensive. ( I Know I’ve asked too much information , Please share as much information as you can).
Thanks
&
Regards
My wife , age 36 is a HIV positive patient . She is currently taking Duovir - N ( Lamivudine, Zidovudine and Nevirapine ) . Please refer to the attachment ‘moni.pdf’ ,
She started taking Nevilast-30( Lamivudine, Nevirapine and Stavudine ) from apr 2007. Somewhere in July 2008 she discontinued the medicine( due to misguidance) and restarted in dec2008 . and then on she was fine , did not have problems. ( CD4=900 , Viral load >20)
We started consulting a very good doctor from 2012 onwards. He was suggesting that stavudine has very strong side effects. ( like uneven fat distribution) In fact her face had very slight muscle loss and hands& legs had become slightly thin. Our doctor suggested a regime change.
So she started taking duovir-N from Aug 2013. From that time onward her cd4 started to go down. My questions are
1. Please let me know if the drop in cd4 is because of drug resistance or because of regime change. Is there a way to find out ? ( I’ve all the reports).
2. If this is drug resistance , she will have to go for second line treatment , On an average How much time will the second line treatment can last ( approx in years).
3. Is 3rd line treatment available in XXXXXXX If yes , in which cities. ,
if no is which countries have this treatment? Is it very expensive. ( I Know I’ve asked too much information , Please share as much information as you can).
Thanks
&
Regards
Brief Answer:
Drug resistance test must.3rd line available XXXXXXX
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
Your HIV physician is correct. WHO and CDC, XXXXXXX and all guidelines phased out the drug Staudine.
1. CD4 drop is not due to mere switching over the ART regimen, but likely to be due to drug resistance.
2. Second line (any drug regimen), if the treatment adherence is good (>95%), then it will be effective for not less than 5-7 years or even more.
3. 3rd line drugs are well available in XXXXXXX They are available in all cities. If there is HIV practicing physician available, then the drugs would be available or made available within a day or two.
Before changing to any new combination, have a drug resistance test and go by the test results, then treatment goal will be a successful one. Periodic monitoring for drug response, drug toxicity are important to realize the untoward effects earlier.
Dr S.Murugan
Drug resistance test must.3rd line available XXXXXXX
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
Your HIV physician is correct. WHO and CDC, XXXXXXX and all guidelines phased out the drug Staudine.
1. CD4 drop is not due to mere switching over the ART regimen, but likely to be due to drug resistance.
2. Second line (any drug regimen), if the treatment adherence is good (>95%), then it will be effective for not less than 5-7 years or even more.
3. 3rd line drugs are well available in XXXXXXX They are available in all cities. If there is HIV practicing physician available, then the drugs would be available or made available within a day or two.
Before changing to any new combination, have a drug resistance test and go by the test results, then treatment goal will be a successful one. Periodic monitoring for drug response, drug toxicity are important to realize the untoward effects earlier.
Dr S.Murugan
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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