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MARIAS FRIEND
Dec 12, 2003

Dr Pierone, thank you for your interest in my situation if you could enlighten me on T-20 I would appreciate it.

Response from Dr. Pierone

How best to use T-20 (enfuvirtide, Fuzeon) is uncertain at this time. This medication is given by injection twice daily, takes some preparation, and is very expensive. It is a very potent antiretroviral and a truly important addition to the HIV armamentarium for persons with multi-drug resistant HIV. However, if it used too late in the treatment scheme as the only agent that the virus is sensitive to, this would be classified as effective monotherapy and limited benefit results. On the other hand, it makes little sense to use in a second or third line regimen because other alternative oral medications are available and effective.

So T-20 is probably best used in later salvage in combination with two other active agents to construct a viable regimen. This is not always possible given the realities of clinical practice. Some people are treated with T-20 with only one other active agent because of profound reduction in CD4 count and the pressing need for treatment. Sometimes T-20 should be "saved" for use together with an HIV medication that is not currently available. For example, we are planning to use T-20 together with TMC-114, an experimental protease inhibitor, for patients with multi-drug resistant infection.

So the decision to begin T-20 depends on your specific situation including drug treatment history, medication intolerances, CD4 counts, and results of viral resistance tests. This information would shed some light on the reasons that your doctor has recommended use of T-20. Good luck to you!



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