Jul 1, 2005
Doctor Young, thanks for your help. I have rather high level of drug resistance which I reported to you earlier. Treatment naive, 200 plus CD4 and 200,000 plus viral load about 2 months back. Based on reported resistance, you advised a nNRTI with tipranivir and others, perhaps Viread (although that is somewhat comprimised). You said there could be drug interaction problems with Sustiva and tipranivir. What might those be? Do you think waiting to start until the CCR5's come on board is a good idea? You also said a phenotype might help. I'm going to do that. What about T20 resistance? You recommend testing for that given the above? Many thanks.
Response from Dr. Young
Thanks for writing back.
After more careful review, it looks like there isn't a significant pharmacokinetic interaction between conventionally-dosed efavirenz (Sustiva) and tipranavir+ ritonavir. So, provided that your doctor has a reason to believe that tipranavir will be active against your virus, this might be a reasonable option.
T20 would certainly be an option and there's no obvious reason to think that there will be any resistance (there's very little in the community at this point).
As for future drugs, like CCR5 inhbitors, the decision to start or wait for new drugs will be based a lot on how you're feeling and the rate of decline in your CD4 cell counts.
I hope this helps, good luck and stay in touch, BY
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