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3 combinations to live?

Oct 23, 2002

I am wondering if in your practice, if you've seen people on triple combination therapy who honestly claim to be 100 compliant still develop drug resistance. I ask this question discarding those patients with suspected drug use and other risky behaviors that make their compliance "suspect" and possibly skew the national data. I'm 2 years into 1st line therapy, and a estimating 5-6 years of success before needing to switch. I am guessing that I have possibly 3 combinations to choose from, therefore, am guessing I have 15-18 years to live. Assuming no additional drugs) I know its a morbid thought but there is alot of planning I feel I must make. I am only 30 yrs old w/a new hous e etc...Am I way off in my projections or have responsible people lasted longer on their 1st line therapy?

Response from Dr. Wohl

While causes of virologic failure of HIV therapies other than sub-optimal adherence exist, patients not taking their prescribed medications faithfully remains a major reason for viral rebound.

Data from some of the first studies of protease inhibitor containing regimens demonstrate that lasting success can be achieved with combination therapy on the order of 6-7 years and still going. These studies enrolled some very motivated patients. So if you are truly very adherent to your treatment, I would be optimistic that your viral load could stay low for longer than you anticipate. The key thing is to take the meds as directed almost without fail 24/7/365.

AS I mentioned there are other reasons for virologic failure of the drugs in addition to sub-optimal adherence. These include problems with absorbing the meds in the gut, starting other agents (including herbal and prescription treatments) that interfere with the HIV therapies and having special proteins in your cells that pump HIV meds out of the cell. This latter problem is an emerging concern and may explain why some people with great adherence don't do as well as expected on HIV treatment.

In your case, I would be optimistic. Before we had decent treatments for HIV, people generally lived an average of 10 years after their HIV diagnosis. Now we have more effective drugs and new ones coming down the pike all the time. People getting diagnosed in 2002 can probably look forward to a double or tripling of the time until AIDS or death. In that time there will be advances in treatment that will further extend how long people live and live well with HIV. You are doing wonderfully on your regimen. I see no reason why you can't live to get old and gray. DW


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