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fuzeon injection questions
Mar 27, 2004

Hello Dr.Cohen, I am directing this question to you because I know you have been very involved with fuzeon. I have two questions-

One: Sometimes when I inject the medicine - some blood will come from the injection site. If by accident I hit a vein and the drug goes into the vein is that dangerous and will the drug be utilized - I would hate to become resistant if my body doesn't absorb the med.

Quest.two- With my other meds.esp. the protease inhib-I am take them every 12 hours-I also take fuzeon every 12-If I am scheduled to take the fuzeon at 8am/8pm and I inject at 8:45-will this cause resistance or is there some leadway?For the first time in 14 years I am undetectable and I don't want to mess it up.

By the way I am on 7 meds-I think I was given the virus from hell!!!!(LOL)

Response from Dr. Cohen

Quest one. I would certainly agree that it is worth trying to avoid hitting a vein or a blood vessel for a couple of reasons. One is just that it is messy. However - if you are injecting this drug into your body - under the skin - even if you did hit a blood vessel and see some bleeding - it is reasonable to expect that you are still getting the benefit of this drug. The first studies of Fuzeon were actually done with intravenous (IV - or into the vein) infusions. And with that approach the drug performed very well. However - it was abandoned more because it was just not going to work for people to get an infusion every day. So we went to the skin injections twice a day. And this approach may work in part because putting it under the skin might create a "slow-release" deposit - that allows continuous exposure to the drug for the next 12 hours. But it is likely that even if there is some bleeding - you did not inject it directly into a vein - it is more likely you hit a small blood vessel and see some bleeding. And having blood at the site should not influence the absorption of the Fuzeon into the body. Though again - it is worth avoiding as I am sure you are trying to do...

Quest two. There is likely to be no reasonable expectation of a problem in having the timing to be a small bit off. These meds are designed to work when given every 12 hours on average. But fortunately these are averages with often some "cushion". Meaning that at 7:59 your levels of Fuzeon are getting low and it is time to get another dose. But in general - these meds are not so demanding that they work at 8:00 but are useless by 8:45. And this may especially be the case now that your viral load is undetectable - there is simply less virus around - and therefore much more of a "cushion" in terms of when you'd need that next injection. And at least during that hour when you are getting ready with the next dose of Fuzeon - some of the other six (!)antivirals you are on are working - maintaining control before you get the next dose going. So while we talk every 12 hours - people do vary - and it is likely that 45 minutes is not going to be the difference at this point between continued suppression and viral rebound.

And Congrats on the undetectable level - the use of Fuzeon has allowed us on average to double the chance of achieving undetectable viral loads on average. And while it is a bit cumbersome perhaps to keep on with it -- it is great to hear of your dedication to do what you have to do to stay healthy and alive.

Good luck.

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