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Meds, How long till failure & switching
Apr 18, 2007

Dear Dr. Ben

Yes, it is one of your friends and patients writing you. Those of us who live in remote areas do not have as many of the answers say someone living in Denver have access to i.e. face to face with others like me (Eric). Ben things have been going very stellar-ly since going on meds 1.3 years ago. Little side effects and really no complaints. I feel 90% of my diagnosis is psychological. Now I know all my hiv on-line friends tell me to stay in the day and not think about tomorrow. However hiv really can push the limits of this mentality. What I ask is probably beyond you giving a definitive answer. The question is this Ok so I am doing well now and enjoying life. What happens when resistance begins on my first line regimen? Will the second line still allow me the ability to do the things I love and to continue to work? Corrective thinking in me is certainly something I am working towards. I know there are no guarantees. But there are new regimens and hopefully by the time I have exhausted the first three, science will have another three.. What do you tell your patients who are no longer treatment naive? I read a bit on CROI conference, but a lot of it is over my head. How about your translating to laymens lingo?

Thank you for everything you have done for me.

Kindest Regards,

Eric

The snow is melting, thank god!

Response from Dr. Young

hi Eric-

It's great to hear from you, as always. It's been my experience that patients like you who achieve undetectable viral loads and remaind adherent to medications very rarely, if ever, have treatment failure and drug resistance. Indeed, with our current set of medications, especially after starting boosted PIs in the last 3 or so years, I haven't had a single patient with failure. So, to answer your first question, I don't anticipate failure happening.

Should it happen (as it does in about 5% of patients starting treatment in the first year), the pattern of resistance after boosted PI failure shows only resistance to 3TC in the vast majority of cases-- this means that there is preservation of all but 2 of the 27 different HIV medications. Second (and with today's drugs, third)- line treatments can and are successful for many patients, and are becoming quite well tolerated too.

It's important to distinguish between those patients who are treatment experienced without resistance from those who are experienced with drug resistance. For the former, we can switch from one drug regimen to another without great risk, so that we can adjust for side effects and the availability of new drugs; for the later, the pattern of drug resistance will necessarily dictate what new drugs can be used.

In general, new drug classes (like the soon-to-be approved integrase) retain full activity in patients who have from no- to very-extensive treatment histories. Indeed, using these classes of medications, my most difficult to suppress patients are finally achieving undetectable viral loads.

Hope this helps, thanks for posting. BY



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