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re: drug resistance
Jan 22, 2006

My partner is pretty much drup resistant after only 7 years on medicine. Is there anyhthing newer since fuzeon that may help him? His cell count is 5 and viral load is over 100,000. He also has developed renal problems and is on dialysis, but his health is fairly good. Just looking for a newer med since he has tried 80 per cent of the older ones. Thanks KB

Response from Dr. Young

KB- Thanks for posting.

The key to managing drug resistant patients is to obtain the best possible information about what drugs retain activity and which ones don't. What that means operationally is to get both phenotype and genotypic testing (not just genotype or "virtuals")-- this information can reveal subtle differences in drug susceptibility that can be exploited to contruct regimens.

Getting all previous drug resistance test and treatment history information is also very important, since this information might nont always be apparent in current resistance tests.

Since the approval of T-20 (enfuvirtide, Fuzeon), the newest "ulta-potent" protease inhibitors, like tipranavir (Aptivus) and the investigational products(PIs: TMC-114 and brecanavir, CCR5 inhibitor and maturation inhibitors) offer significant promise for the next year or two. Combining two or more of these new drugs classes may prove to be very potent, even for persons with highly drug resistant virus.

Lastly, it's also very important to note that patients like your partner, with few obvious drug options clearly do better when on treatment (even if non-suppressive) than off-- maintenence of a nucleoside drug has been associated with less CD4 cell decline and fewer AIDS-related complications. 3TC monotherapy, as unconventional as it sounds (and certainly not recommended for the vast majority of patients) has seen some use in this setting.

So, hang in there-- newer drugs with improved potency are here and coming. Good luck, best health-- BY



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