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Meds at 4.5 Months
Jun 10, 2006

Hi Ben

Hope your Euro trip went well. Missed you last week in Denver. Hit the back country with the jeep last weekend and winched myself out of a snow bank. Skiing is still alive and well.

As you know I have been pretty active in TheBody and sometimes I need to be recharged after listening to countless interpretations of what HIV / AIDS means to the newly infected. I have actually backed off a bit because it is truly a draining and sometimes discouraging thing to support and support and support. I can understand how an HIV Doc must feel dealing with this day in and day out 24/7. I have been reading quite a bit of your posts Ben of late regarding death sentences etc. If only the crystal ball factor was not part of the formula, I think us +ve folks would feel more assured.

My question is (now that I am a med guy).. I have heard through some reliable sources that hit it hard, hit it early is not always the best approach. That you could possibly deplete your regimen choices within say 10 years? Well that statement really rubbed me wrong and got the wheels spinning. Granted the drug-discovery-pipeline is working on resistance and better tolerated meds. Could you in good faith say that 10 years is off the mark? Given adherence issues are 100% and one does as he is told by his HIV Doctor. Having faith in ones ID Doc is a very critical aspect of continuing going on about life. Did you realize how important you were?? I would love to say in 10 years that I have been on the same regimen and it has been working great. I know resistance will develop. I would just rather say later than sooner and sleep well at night. And know that when and if that day comes, I get to go on a second line, third and fourth line by that time.

All my best to you and your Team!

Eric

Response from Dr. Young

hi Eric-

Great to hear from you. Ukraine was yet another moving experience (though sobering to know that many tens of thousands of HIV+ patients desperately need, but don't yet have access to medications). We're having our early summer here in the Central mountains, still plenty good for the earned turns though (you'll know what I mean).

Now to your questions.

So much of the "conventional wisdom" is based on our early experiences with HAART-- regimens that could suppress the virus, but generally required religious faith in adherence and tolerance of side effects. The end result is that many patients experienced failure and drug resistance of first line regimens within the first year or two of treatment (crude guess: ~40%).

Newer regimens are clearly easier to take and adhere to, treatment failure is a pretty uncommon thing among first line patients. Indeed, I just had this very conversation with my partners; none of us has seen treatment failure with drug resistance among first-line, adherent patients for at least a couple of years, if not more-- this is categorically different than the experiences from 10 years ago.

Given this, I'd have a difficult time suggesting that my patients will exhaust all current treatments in 10 years, and this even assumes that there will be no new medications or classes of drugs (also not a true case). Resistance may develop in some patients over time, all I'm saying here is that it's pretty rare to see these days; so much later than sooner is my prediction.

One last point, 10 years ago, second- and definitely third-line regimens were pretty dodgy- the likelihood of success with these seem more like hoping than confidence. This clearly has changed too. I have little doubt at all that second line treatments will work (indeed with likelihoods that approach first line ones); even third line treatments should work well (perhaps not as well tolerated0 as first liners.

So, I hope this finds you and Will well; sleep well and enjoy the Roaring Fork valley for me. BY



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