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What next?
May 17, 2006

My most recent test shows resistance to everything. I have been on just Kaletra for past six months. my vl got down close to undetectable for first time in 18 years of drugs,but is back up to 5000. Ts have been falling a little each time period and are now at 220. I have an opportunity to get in a tmc114 trial now. Do you think I should do this mono or wait till another new drug comes along so I can do two at the same time.

Response from Dr. Wohl

I would not blow TMC114, which may (MAY) have some effect against your virus and would couple this drug with at least another 1 (or 2) agents that might also work.

Are you or have you ever been on Fuzeon? If not, this plus TMC114 might be an option. Some centers are also studying integrase inhibitors and some of these studies do permit TMC114. Entering an integrase study where you have a high chance of getting active drug and also starting TMC114 + Fuzeon (if you have never been on it) would give you a good chance of getting this virus under control again.

Another alternative is to see if your virus is sensitive to tipranavir. A presistance test (both genotype and phenotype) could be useful here. If your virus is sensitive to this drug it could be used as an alternative to TMC114.

Bottom line: don't waste a single agent. Combine new drugs with at least another drug likely to work.

DW



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