Jul 28, 2003
Good day.. I am Resistance to all the drug, Will T-20 or Atazanavir, Emtricitabine (coviracil FTC )or Tipranavir or TMC-125 or TNX-355.... What are the best drug for me right now.... T 4 cell 68, Viral load 125,000 Thank you have a great day
Response from Dr. Pierone
I am going to make a few assumptions for the sake of this discussion. If you have virus that is resistant to all currently approved antiretrovirals then the best options will likely be either the second generation agents from the existing classes, or one of the completely new class of drugs.
FTC and atazanavir are unlikely to have much impact against really resistant virus based on what we know about resistance patterns (although data are limited for boosted atazanavir).
The second generation agents we can define as having activity against virus that is typically resistant to existing agents in the class. Examples would be tipranavir (protease inhibitor), TMC-114 (protease inhibitor) and TMC-125 (NNRTI). Tipranavir is well into phase 3 and should enter expanded access fairly soon. TMC-114 should be entering phase 2 studies soon. TMC-125 should be entering phase 2 soon as well (we all hope).
Since T-20 is the first member of fusion inhibitors, this should work for anyone with virus resistant to all available agents. It would be helpful to combine it with at least on other active agent(s) like tipranavir or TMC-114. Very preliminary (and very impressive) data was presented on TNX-355 at the Retrovirus conference in February, still very early.
I think that it is fair to say that in your situation, with resistant virus, relatively high viral load and low CD4 count you would probably be best served looking into a clinical trial of one of the newer agents. Best of luck to you.
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