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STI advice
Jul 21, 2002

Dr. Young, I've written in the past with questions covering most every topic and your responses have been clear concise and generally wonderful.I need your imput on a sticky area as I am trying to get a consenseous from as many qualified DRs. pharm's etc as it is a situation that has to be judiciously approached.In the very near future(next few weeks) I will be enbarking on a seriously needed sti.I'm a very good candiadate have a doc who is backing me 100 and although we didn't iron out the fine details of our"preset parameters" that's for the next visit. My biggest issue is how to comeoff the drugs with the least risk(I know there are no 100 guarrentee's)So, my cd4 is very high my vl is nonexsitant and I have a resitance only to 3tc from several years ago, probably from a dual therapy induction.I have taken lot's of drugs in the past, no resistance just trying to minimize side effects.I had labs drawn about every 8 weeks although that close of monitoring wasen't required I just approach things from the cautious side.My current regimen which I will be leaving poses the problem as the half live's are all different and this will be tricky.I am deleting viramune viread and viracept.I know the pi shouldn't be too much of a risk because of the short half life and even if A problem were to arise, from my understanding viracept has a unique pattern that doesn't impact cross resistance as badly as some of the of the pi's.Also, I haven't used the bulk of the other pi's(crix and that was along time ago for a short while)my concern is of course the viread and the viramune.I had a pharm tell me the half life of viread is similar to viramune so I'm guessing these would go at the same time. I'm getting alot of different thoughts and I really respect your intelligence so I would really value any opinion you might have as well.....Thank you

Response from Dr. Young

Thanks for your question.

You are right in the summary about the half lives of the different medications that you're taking. There is no good clinical data about the best way to discontinue medications, so we have to make our best educated decisions and recommendations. I'd probably discontinue the longer-lived medications (tenofovir and nevirapine) the day prior to discontination of the shorter-lived medication (nelfinavir).

There is some recent data that would suggest that the greatest risk of developing resistant virus actually doesn't occur during discontinuation of therapy, but maybe greater during treatment reinitiation (since there is a lot more virus). If so, this issue may not be as critical as we think that it is.

Good luck, BY


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