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Present Combo Failing ...but...What to Try??
Apr 28, 2004

Good Afternoon,

I have been taking an incomplete combination therapy for approximately 4 years...initally I was taking Viracept, Fortovase, 3TC and D4T...but had to drop the D4T due to very severe neuropathy.

So I have continued to take these drugs really just to keep me going until other drugs come along. Now that there are new drugs to choose from...what combination would you suggest given the following constraints:

1. Only nucleoside drug I can tolerate is 3TC

2. Have been saving the non-nucleoside drug class till now.

3. I really do not tolerate Norvir at all well...

I recently had gotten enthusiastic about Reyataz because of my severe lipoatrophy/dystrophy, but see that if it is taken with either Viread or Viramune, it must be boosted with Norvir.

Can you help me please. My doctor is not an HIV specialist, so I am pretty much trying to create my own new combination of drugs.

I neglected to tell you that my viral load has ranged from 1,500 to about 600,000 during the past 3 years...and my T cells have stayed in the 220-260 range, though they are dropping now. I am very compliant with my medication regime.

Thanks so much!!

Response from Dr. Lee

You are in a tough spot. First to have stayed on and been "very compliant" with an incomplete regimen while running viral loads of up to 600,000 has most likely set you up for complete resistance to all protease inhibitors and to 3TC.

While only testing can positively determine the genotype, I suspect that you no longer have the options you are discussing. Thus, you need to be considering other nucleosides (this is probably very important) and even take medicines to offset side effects if necessary (such as erythropoeitin if anemia is a problem, anti-emetics if nausea is a problem, etc.) You could utilize a non-nucleoside regimen but it needs to be coupled with a FULL regimen including nucleosides. If your doctor is not HIV knowledgeable you should see someone who specializes in HIV for a consultation or two. Consider genotyping or phenotyping before you stop your meds.

Be well.



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