But it rarely says anything about your health today. Therefore, if you are on a third regimen, select a therapeutic goal that's realistic for you, e.g., reducing your viral load by 0.5 log or more from baseline. If you are on a third regimen and unable to reduce your viral load, there is evidence that antiretroviral therapy still may help you. Data from San Francisco General Hospital show that therapy provides a clinical and immunologic benefit for 2 years or longer in many patients whose plasma viremia is not well controlled. Antiretroviral therapy may have a clinical benefit independent of its ability to suppress viral load.
Adherence is the most important factor associated with the virologic success of therapy.
If you are unable or unwilling to adhere to your current regimen, consider changing it. If you are not yet heavily treated and have a moderate to high CD4 T cell count, you can put together a dual NRTI combination that involves few pills, no food restrictions and twice daily dosing. The doctor will say that's heresy, that 3-drug therapy is best and that 2 NRTIs alone are likely to select for virus resistant to that whole class. Investigators have demonstrated that a dual NRTI strategy provides clinical benefit, and it leaves the powerful protease inhibitors and non-nucleoside reverse transcriptase inhibitors available for later use, when your T cell count is lower and you need potent therapy. If you are unable or unwilling to adhere to any antiretroviral regimen, one other option, depending on your baseline CD4 T cell count and viral load, is to withdraw from therapy altogether until you are ready to commit.