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We need help with alternative meds?
Jan 30, 2002

Doctors, My friend is resistant to everything now. There are no clinical trials for him at present and his doctor is recommending alternative meds. But he doesn't know anything about it and WE NEED HELP! His viral load is up to 500,000 and his CD4 count about 87. Please send us in the right direction fast. Thank you.

Response from Dr. Young

Thanks for your question.

The best data on this situation (unfortunately one that we see with some regularity in our office) comes from Deeks and colleagues from the San Fransisco General Hospital (see New England Journal, 2001)-- these data suggest that even in the face of resistance, patients with highly resistant virus do better when on so-called HAART, even if their viral loads are detectable.

Persons who discontinue medications were more likely to have AIDS related complications, even though they were less likely to have drug-related complications-- making the point that even partially effective medications are better than none, when the CD4 counts are low.

Why this happens is not entirely clear, though it has been suggested that having resistant virus around (driven by drug-selection) leaves the virus less fit than wild type-- hence, less likely to cause damage to the immune system.

In practice, I will place patients like your friend on the best tolerated multi-drug regimen that I can find, hopefully one that has the maximum degree of viral susceptibility (determined by genotype or phenotypic testing).

As for alternative meds, I'd proceed cautiously, since there is little data for benefit. Indeed, occasional bad and unexpected interactions with "alternative" products (like St. John's wort or garlic supplements) have been observed.

Good luck, BY



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