Abstract
Case: A 22-year-old Japanese male with hemophilia B and AIDS was described. His clinical course had been complicated by recurrent herpes zoster and oral candidiasis. Poor adherence to former antiretroviral therapy might have been associated with the multi-drug resistance in genotypic analysis. After starting a regimen consisting of stavudine, lamivudine, saquinavir, and nelfinavir, substantial improvements both in CD4+ cell counts and clinical status were seen despite his plasma viral load consistently showing titers above 4.0log10 copies/ml.
Discussion: A number of patients who initiate highly active antiretroviral therapy eventually experience virologic failure. Medication for such patients has been switched based on the viral load, a surrogate marker for clinical progression of HIV infection. However, these patients have few therapeutic options. What constitutes failure of antiretroviral therapy is still controversial. It may be premature for clinicians to change antiretroviral therapy solely on the finding of detectable viral loads.
