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Very Concerned
Feb 22, 2006

Dear Doc,

First, I have tested poz. In Oct. I have not yet started Meds. I have a wonderful HIV doc that I trust very much. I have three questions and Ill try to make it brief. 1. I have been reading some new developments that have stated that its better to start therapy early rather than late. Does this mean not it is before CD4 count of 350? What are your thoughts on this matter? 2. I hear a lot about drug resistance and know that it is a very big problem. What are the chances of a newly diagnosed person (never on meds) being resistant to all drugs that can save my life? Ill know my geno type results when I visit my doc on Mar. 9. 3. Do you think that the new encouraging results on Integrase Inhibitors announced at the conference in Denver will make it to those who are drug resistant in the near future as a routine therapy and not as expanded access only? 4. Last, and most importantly, is it possible with new medicine and access to care that I can live a normal life span. I am not a smoker or have confection and only drink in moderation.

Response from Dr. Young

Thanks for your post. Your questions cover a lot of the most relevant topics.

1) There is a growing amount of data that suggest to me that it's much better to start treatment at least with counts around 350 than with lower counts-- around 200-250. This is because of many reasons, but to me some of the more important relate to the increased frequency of side effects and complications when starting later. (This seems paradoxical, since most delay treatment to avoid complications.) Moreover, though not globally recommended, the time one can stay off medications in a treatment interruption is related to when you start-- the lower the count, the less likely you can stay off treatment for a long time. With newer, better tolerated and less toxic medications, the trend towards starting earlier dosen't come with too many intrinsic side effects or impact on quality of life. It wouldn't surprise me that we'll be talking about starting treatment with CD4s in the 400's in the years to come.

2) Transmitted drug resistance occurs in about 10% of US patients. Fortunately, multi-drug resistance remains very infrequent- less than 1%. Either way, this provides strong evidence that drug resistance testing should be performed in all patients, even before starting medications-- just as your doctor has done.

3) Yes, there has been quite encouraging preliminary news about integrase inhibitors-- from Merck and Gilead. There is only limited access to the drugs now-- only in clinical studies. Expanded access programs (EAPs) are generally available only after the dosing is figured out (after phase 2 is completed) and after the pivotal phase 3 studies are well underway. At this pace, it will still be a year or two before we see the first EAPs.

4). Yes, you can live a "normal" life span with a "normal" quality of life. Newer, currently used medications offer the real hope that every patient taking a first line regimen can have no side effects.

5) Good luck, good health. Thanks for posting. BY

HIV1 and 2 negative
treatment fo MAC

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