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new combination lasting?
Sep 27, 2007

I have been positive since 1988, and for the last 8 years have been resistant to everything, my tcells staying under 50, and for the last 2 years around zero. I have been lucky and have had only sore mouth (thrush). I started Fuzeon with nothing new so lost that one too. The only med I have never taken is Tipranivir, except for my new combo. My viral load was off the charts.

I recently started raltegravir, TMC125 and Prezista. After the first 4 weeks, my viral load went down to 1500 and my t-cells up to 34. I am most happy with this for only 4 weeks, I hope maybe for the first time I can become undetectable and get above 100 t-cells. My fear is, because of all the previous times it has happened, becoming resistant. This seems like a powerful combination to achieve the results I got, but usually, after a month and the first good results, it goes the opposite (bad) way as far as test results.

Can a person expect longer term results when they have been so resistant? I took viramune for some time, only 2 weeks for sustiva (bad side effects) and never took the 3rd, so I don't know how much tmc-125 is contributing, and being on so many protoase inhibtors before, the only new drug here is raltegravir

Response from Dr. Young

Thanks for your post.

Assessing the net potency of salvage regimens, like yours can be difficult and the source of a lot of apprehension.

First off, it is entirely possible that you have activity from both the TMC-125 and darunavir (Prezista). I'd wonder if your doctor had run genotype and phenotypic tests before choosing these medications. While you're correct that your previous NNRTI experience may decrease TMC125 activity, we've seen patients with extensive PI treatment history retain phenotypic sensitivity to darunavir.

Your "off the charts" to 1500 viral load drop after one month is highly encouraging--if your viral load was 150,000 before starting, this is a 2 log, or 99% reduction. This is predictive of longer term durability. If your initial viral load was higher, then even better.

Given the recent start on this regimen, I'd have to ask if your doctor also considered using maraviroc (Selzentry)-- the newly approved HIV medication. Having a very low CD4 count makes it less likely that the drug would be appropriate for you, but worth a try.

Lastly, in the early studies of the integrase inhibitor raltegravir, a significant percentage of persons had durable viral suppression even when the other drugs in the regimen didn't appear to contribute much to the strenghth of the regimen.

So, here's to a little bit of luck and best of health to you. BY



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