Why, after years of high viral loads, are some long-timers suddenly undetectable?
They’ve been hanging on, with daunting viral loads (VLs) and basement CD4 counts. But their lab tests have delivered an early holiday present: undetectable virus and climbing CD4s. This year, some longtime survivors, whose HIV developed resistance to most available meds, were presented with several powerful new drugs to try simultaneously. And hitting the virus with more than one new med at a time allows them to control HIV.
First, in June, the FDA approved the protease inhibitor (PI) Prezista (TMC-114). Meanwhile, the first integrase inhibitor, MK-0518, and a non-nuke, etravirine (TMC-125), became available through expanded access (ask your doctor). And another new lifeline is on the way: The entry inhibitor (EI) maraviroc should also offer such access early next year.
Houston’s Nelson Vergel, 47, a veteran advocate for the med-resistant, says we’re finally “at a tipping point.” Diagnosed in 1986, he’s never had an undetectable viral load and recently hit a CD4 low of 180. Four months after adding Prezista and MK-0518 to his old combo, his VL has vanished—and his CD4s have hit the 400s.J.D., 51, of Los Angeles, diagnosed in 1988, had a similar experience. Adding Prezista and etravirine to his regimen boosted his CD4s from the low 100s to 450. “I’m not undetectable yet,” he says—his VL hovers between 30,000 and 50,000—“but to go from ‘probably gonna die’ [including multiple hospitalizations] to over 400 T cells is amazing.”
Only future study data will determine what side effects- these meds may have, but so far, Vergel says, his sole MK-0518 side effect has been flatulence. “But with 414 T cells,” he says, “I’m happy to be gassy.”
