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stubborn numbers checking in
Nov 25, 2006

Hi Dr Young,

How are you? I still check in to read your forum sometimes. You always make me smile. Thank you so much.

I thought you might like an update (I'm "stubborn numbers" from back in Aug/Sept) My numbers are 186 (15%) and 180,000. Previously they were 162 (11%) and 290,000. I'm on fuzeon+sustiva+tenofovir, because I had high resistance levels to PIs and NRTIs. I have been very adherent. Since september I've only missed two doses of tenofovir and none of the others. My doctor and I are not ecstatic about the results, but I did get a stomach bug and was ill for most of october.

I am having a few problems with painful fuzeon injection sites. I rotate the sites and everything like i was told, but they're still quite sore. Do you think this numbers turn around is worth the inconvenience? Or should we try another regimen? My doctor favors waiting for another round of labs.

Thanks again for your time, humor and compassion.

Sally

Response from Dr. Young

Sally, thanks for your follow up and kind words. It's good to hear from you again.

I share your and your doctor's lack of excitement about your labs-- really only a slight decrease in your viral load; nevertheless, the slight increase in your CD4 is in the right direction.

Injection site reactions can dog treatment with enfuvirtide (T20, Fuzeon)-- rotating the sites and massage can help; though for some patients, this can really make T20-based treatment difficult.

I do think that getting another set of labs while your not sick is worthwhile; I'd expect to see a much larger (~95%) decrease in the viral load if the regimen was sufficiently potent against your resistant virus. The bother is that it's quite likely that T20 and efavirenz (Sustiva) resistance will emerge quite rapidly if the VL doesn't get undetectable in a reasonable amount of time.

Yes, if your viral load doesn't get undetectable, another regimen is probably in order. I'd start by getting the best drug resistance testing possible. Genotype and phenotype together are what we use for patients with highly drug resistant HIV. Fortunately, there are a number of newer drugs that may have significant activity against your virus. For example, darunavir (Prezista) is a PI approved for use in highly drug resistant patients (ask your doctor if this might be an option). Expanded access programs for new drugs may also permit the construction of a potent drug regimen: TMC-125 is a second generation NNRTI; maraviroc (CCR5 inhibitor) and MK-0518 (a integrase inhibitor) all have promise- particularly for patients like yourself.

I hope this helps. Best of health to you. BY



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