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Ask the Experts about Choosing Your Meds
Mega HAART combination?
Sep 13, 2006
Once again I am in the position of a failing combination with my cd4 at 100 and my vl at 750,000...up from 50,000 a month ago. I am a long term survivor (22 years)that is highly resistant to all current meds including tipranavir. My current combo is epivir,viread and t-20. Like others in my position, I am eager to have more than one new drug for my next combo and until the drugs that are in the "pipeline" get to expanded access it looks like my "bridge" will be a mega haart therapy. How does one go about selecting which of the resistant drugs to put together when you have a patient like me that is highly resistant to everything? I have searched for information regarding possible combinations with not much luck. Is the idea behind mega haart to "blast" the virus? Do you look for the best of the worst with my old drugs? Is there any merit to rotating mega haart combinations to really keep the virus guessing? I am very compliant so I am not worried about scheduling etc.. Any thoughts would be greatly appreciated! Thank you in advance!
Jeffrey
Response from Dr. Wohl
HIV meds used to fight multi-drug resistant virus are of two general types: those with activity against the virus and those that will force the virus to maintain mutations that inhibit its ability to replicate.
So, when crafting a regimen for you, the idea would first be to find as many drugs that can be expected to have some activity against the HIV in your body. Darunavir (Prezista) is a new drug that may work even though testing suggests tipranavir won't. TMC125 is a drug in the pipeline but in expanded access now that works against efavirenz/nevirapine-resistant viruses. The Merck integrase inhibitor will soon be available, I suspect, for expanded access, too.
One could look at your genotype and phenotype resistance tests to see if there are any meds from your past that can be recycled - drugs that you do not demonstrate (much) resistance to.
Keeping some AZT and 3TC or FTC on board even though you are resistant to them may help reduce the fitness of your virus by selecting for strains that are mutated and less functional.
DW
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