Oct 18, 2003
I appreciate your response to my question regarding life expectancy and the durability of treatment options. However, I'm still confused. I read your response that the "average" durability is 18 mos. This surprises me because I would have thought from all that I have read that it would be much longer than that. Case in point, on the same day, a posting on this website reported that 99 percent of people on Kaletra had surpressed VL <400 for 5 yrs and 94 percent VL <50 for 5 yrs. Am I missing something? Perhaps (probably) my question was too broad. So, assuming a) no pre-existing resistance and b) 100 percent adherance does that affect your reply. Or am I missing something else. I appreciate your sober (not somber, sober) assessments, because I don't want a sugar coated answer. Beng a regular reader of this website I know you always endeavor to not give false hope but these numbers don't seem to correspond and I can't figure out what I'm missing.
I guess the subtext of my question is that my numbers are borderline as to whether I should start meds now or not. One of the factors I'm trying to weigh is based on the durability of my treatment options. I want to live a long time on the meds once I start. But if all meds ultimately fail at some point then waiting to start (CD4 and VL numbers permitting) seems to make sense if my objective is to maximize my time on the meds.
Thanks for your time and all the great work you doc's do here. It means more than you can know.
Response from Dr. Young
Thanks for your commens and kind words. It is truly meaningful to know that our work is important and has a positive impact.
The 18 month figure comes from previous studies, using "previous" medication regimens, and with a previous level of understanding of the importance of adherence.
Newer studies with newer medications have shown impressive results. The difference between the two numbers reflects history, and the well characterized difference between how patients in clincal studies and patients in the real world do. The later tend to have more issues (or factors) that make adherence more problematic (and are often the basis for exclusion from clinical studies, too).
Getting to your questions, if there is no pre-existing resistance and there is 100% adherence, the liklihood of long-term response is excellent. Again, treatment failure is exceedingly rare in my practice under these circumstances.
If you think that you can be adherent to medications and your numbers are in the range for starting, then the durability of your initial regimen should be optimal. Treatment failure is not inevitable, but does happen-- newer medications address both the needs of first-line and subsequent lines of treatment. I think that the long-term prognosis is very good and I would not use the potential for less that infinite durability as a reason to risk having an AIDS complication or further immune decline. BY
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