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Resistance Shown to all drugs - time to add Fuzeon?
Sep 27, 2004

Tested HIV+ in 1985 (asypmtomatic). Started AZT 1984 and went through many HIV drugs. In 2000 stopped Crixivan & others (CD-4 229 & VL 13000) and started Kaletra & ziagen. Now my CD-4 is 291 and viral load is 16,000 (usually stayed around 7000). Due to the last phenosense test which showed resistance to all HIV meds - Dr has switched me to ziagen- viread- norvir- fortovase and wants to add Fuzeon. Is this the time to add Fuzeon or should I wait a while? Health has been pretty good but fatigue has been becoming a more significant issue this year. Am concerned that if I burn through this new regimen (with fuzeon) in two to five years (which is how long most therapies have worked on me) will there be anything left to try? Thanks for your ideas.

Response from Dr. Holodniy

The devil is in the details. Fuzeon will only work effectively for you if there are at least 1, but more likely 2 other HIV drugs that also have activity. It will not work in a regimen, which shows complete resistance. That means fuzeon is acting like a monotherapy drug. Fuzeon works better in people with higher CD4 counts and lower viral loads (which you have) and less well in people who have experienced or failed Kaletra or viread containing regimens. I would also be interested in the replication capacity (RC) that would have been obtained with the phenosense assay. If the RC is very low, I might be inclined to just hold on the fuzeon for now and maintain a regimen that keeps your CD4 count where it is with that level of detectable viral load. Your CD4 count is pretty respectable. Obviously you would want it higher. But you are not in dire straights at this point. Depending on what PI mutations are present, you might want to wait until tipranavir (new PI that works against many PI resistant strains) comes out in expanded access (late this month or next month) and start that with the fuzeon.



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