Managing HIV/AIDS Therapy in Treatment-Experienced Patients How do you assess a patient failing treatment?
	Enlarged Version of Graphics Below	Dr. Bellos (OC): If I suspect that someone is beginning to fail a regimen, what I really look for is the trend. I look for a trend upward in viral load, or a downward trend in T-cells. For example, if I see someone who has been undetectable all along, and then, we gradually start to see a rise in viral load, say to 1,000 copies, and then at a repeat, it is 5,000, and then 10, and then 15, and the subsequent decrease in CD4 count, that's a factor for me that would initiate a change of the regimen. Dr. Wohlfeiler (OC) : First talk to them about whether or not they're really taking the regimen. And frequently I find that they haven't been taking it or they haven't been taking it consistently. Dr. Wohlfeiler (VO): If that's the case, then what I'm going to do first is ask them to try to commit to at least four to six weeks of not missing any doses. And then recheck viral load and see if it's suppressed the virus. If it hasn't, then you know that probably they have developed resistance and you're going to need to make a switch. If you need to make a switch, then I really believe in doing resistance testing.   See Slide Dr. Wohlfeiler (OC): I happen to like getting as much information as possible. So I like the combination phenotype-genotype test that will give me both the actual mutations and also a phenotype showing susceptibility to each of the drugs. And then I use that to guide my changes.
Program Menu	Last   |	Next