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how long fro meds?
Jun 26, 2002

I was diagnosed with HIV a year and a half ago, and also diagnosed with Hodgkin's. I started HAART (Kaletra and Sustiva) right away, and underwent chemo and radiation for teh Hodgkins. My viral load started at 15,000 and my cd4 count at about 150. The viral load qucikly became undetectable and has remained so. The cd4 count went down to less than 100, but is now up to 167 (I finished chemo and radiation about a year ago). The HAART regimen stills seems to be working. I am also taking Bactrim as a prevenattive. How long might I expect the combo to remain working? are there other drugs I could take if this regimen fails? How many years do i have left? I am 39. I drink occasionally 1-2 glasses of wine. Is this a problem?

Response from Dr. Young

Thanks for the question.

Provided that you can find the ways to be religous about adherence, the regimen should perform well for years. Efavirenz (Sustiva)/Kaletra is a novel, and not well tested regimen as part of initial therapy, but has been tested in part (in combination with nucleoside RT inhibitors) in the Abbott 957 trial -- in this salvage treatment study, the combination performed excellently. I am supposing that your doctors avoided the use of nucleoside RT inhibitors because of possible interactions with your chemotherapy.

There certainly are a number of medications that can be used should this particular regimen fail; one concern that I would have is the potential to have significant cross resistance at time of a Sustiva/Kaletra failure-- we would expect that efavirenz resistance would be the first to occur-resulting in cross resistance to the entire NNRTI class (this is not unique to this regimen). If you were to remain on a failing regimen for a long period of time, the risk of protease inhibitor resistance would increase-- this is the question mark. It currently is not known what exactly the resistanc pattern after Kaletra failure is-- simply has not been reported yet in patients receiving Kaletra as part of initial therapy. Taken together, this is an argument to make sure that you dial in the adherence and definately make sure to have viral load testing on a regular basis.

How many years? You've started out with pretty advanced disease and one serious complication. I'd still vote for decades of life expectancy; but again, this will depend on lots of factors and at least a little good luck. One or two glasses of wine shouldn't be a problem (though you might find yourself less alcohol tolerant), provided that drinking does not interfere with adherence.

Good luck. -BY



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