Oct 25, 2004
I was on my first regimen of Trizivir for four months in 2001 and had to stop due to the muscle cramps from AZT. My doctor then put me on a combo of Ziagen, Epivir and Viramune. About two weeks into that regimen, I woke up with red ring spots on my wrists and ankles and my doctor had me immediately stop all meds.
Last year, I started a regimen of Viread, Emtriva and Viramune and was undectable after 5 months but last month (13 months into the regimen) I had a blip of 331 and my doctor really isn't sure what to do next other than wait to see what the next blood test indicates.
I am worried that I may be developing resistance to Emtriva and/or Viramune/Viread and am getting nervous that my nuke backbone choices will be limited on my next regimen.
How dangerous would it be for me to try Ziagen again? Is there a safe way to reintroduce the abacavir if you don't know if you had the hypersensitivity reaction?
I have not taken any protease inhibitors and show no phenotype resistance to any of the PI's. My phenosense test showed no drug resistance whatsoever.
From my reading on this site, it sounds like Reyataz/Norvir and a strong nuke backbone would make the best choice for the next treatment option if I am failing a regimen but I just would like to be able to choose from a more side effect friendly nuke rather than AZT/D4T/DDI.
Also, are there any new nukes in the pipeline for possible approval in 2005?
Thanks for the good work!!!!
Response from Dr. Pierone
A blip to 331 is not cause for alarm and it makes sense to wait for repeat labs to see if this is just a blip (most likely) or if it is a harbinger of virologic failure. Even if it turns out to be bad news, you will still have many treatment options available. It would be premature to start devising a possible future regimen unless there were confirmed virologic failure and you had a resistance test to guide therapy. Based on the history of a possible Ziagen reaction it would not be prudent to reintroduce this agent.
For individuals that are failing a NNRTI based cocktail, it is becoming increasingly popular to use Norvir/Reyataz together with various nucleosides (depending on the resistance pattern). There are no nukes in the pipeline for 2005, but several are being actively developed. Thanks for posting.
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