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choice
Aug 10, 2005

I need to make a decision concerning my meds. I am a "deep" salvage person. My latest numbers show my t's at 70 and vl at 250k. I am taking viread,kaletra and spzicom. I take the viread only twice a week due to elevated createinine levels. I had hoped to get enrolled in an integrase study here at UCSD - I did not make it due to my kidney functions. I also was recently diagnosed with KS and CMV retenitis. One Dr wants me to wait until I can get on expanded access for TMC-114 and user that with t-20. MY primary Dr is getting anxious, He prefers that I start on the tipranavir and t-20 and whatever else we can think of. Word out of UCSD that ccr5or ccr4 studies won;t be a go for sometone like so, myself for several months. So do I go for it now with the tipranavir and t-20, or wait until Sept or Oct for the expanded access for TMC-114. thanks Dr. Young

Response from Dr. Young

Thanks for your post and questions.

Seems like your in a difficult situation, to summarize-- you've got highly drug-resistant virus, a very low CD4 count and new opportunistic infections.

In this circumstance, I'd vote for doing something sooner than later. (If you were asymptomatic, waiting could be entertained.) Your best apparent options are to use T20 (Fuzeon) now with the best "optimized background" therapy- possibly to include tipranavir (Aptivus). TMC-114 or GSK-385 are investigational protease inhibitors that offer some additional hope, but their availability is limited to clinical trials or a future (a little too far off, in my view) expanded access program.

Also, if your kidney function is too high to consider the integrase studies, wouldn't it be worth considering stopping the tenofovir (Viread) in the hopes that your labs might improve to the point of inclusion in the studies? It's not obvious to me that you're deriving much benefit (at least by viral load or by AIDS complications) from the current treatment combination.

Either way, since one can obtain phenotypic resistance testing for tipranavir now, I'd strongly encourage that this be performed prior to launching into a tipranavir-based treatment.

Best luck, BY

Best luck, BY



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