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What is 908? Dr wants me on it....
Jun 28, 2002

Dr. Young,

I have been HIV+ since Feb 2001. My doctor is waiting for my most recent labs to come back, but he thinks that it may be time to start on meds. (I have not been on any medication in the past)

He is touting something called 908 which I understand to be an experimental drug that works with other approved drugs to increase the amount of the PI's in the body.

He also stated that since it was a "study", the drug company would pay for all doctors visits, labs, meds, etc.

I am seeing this doc out of network, so he isn't getting much from my insurance company. (60 of the "maximum allowable")

I have three questions:

Have you ever heard of this "908"? What are your thoughts? (by the way: VL: 180,000 CD4: 400 on last visit)

Doc would get alot more money than he is now if I am on the study. (Drug company paying vs. insurance company) Do you think that there might be some financial motivation at work here?

Since receiving this info, I've felt fine physically, but my heart feels like it weighs a million pounds right now. The sadness reminds me of how I felt when I first found out I was poz. Is this normal?

Response from Dr. Young

908 is a new chemical formulation of the protease, amprenavir. Amprenavir is a potent protease inhibitor with interesting resistance profiles. Unfortunately, APV's formulation required lots of large volume pills. Needless to say, this prevented the drug from being used widely. Moreover, the drug's formulation (the vehicle mixed with the actual drug) often resulted in gastrointestinal upset and diarrhea.

The formulation of 908 overcomes many of the shortcomings of APV. The chemical is actually a pro-drug that is metabolized rapidly to the active drug, amprenavir. It's chemical formulation permits much more compact pill formation and fewer side effects. Like APV, it retains the promising resistance profile. Initial results of trials should be presented at next week's World AIDS Conference; but ear-to-the-ground sources say that the drug appears to perform very well.

As for going onto a study; I share the dual roles of patient-advocate and study coordinator in our office. These are difficult roles to balance, for there is, indeed the potential for conflict of interest, as you point out.

I try to settle the issue by trying to first determine what kind of drug regimen makes the most sense for the individual. Then (and only then), we try to match that chosen drug regimen with the availability of a similar regimen on a research study.

The decision about when to start therapy should not be based on the availability of clinical trials, but should be made in the absence of pressures about trials-- this is the topic of many discussions on TheBody.

Clearly there is a financial incentive for both researcher (better reimbursement, fame(?)) and patient (fewer copays, better monitoring and testing). If there is any doubt about motivations, I'd have reservations, particularly when participating in trials about yet to be approved drugs.

The mission for us in HIV drug discovery is very important, without new drugs and better information about old drugs, we'd still be in the pre-HAART era. There is a very urgent need to bring newer, better products to market, yet the process needs to be done in an ethical fashion (the rules that govern this process are the consequence of the Nazi medical experimentations during WWII). This is a mission and task that I think that we should also take very seriously.

I hope this is informative. Stay in touch. -BY



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