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Ditch Ziagen for Isentress?? Help

Mar 16, 2009

First, thanks for helping all of us. You're the Best!! I was Dx w/ HIV (Tcells:195)/HVC/HVB/malaria/HVD/west nile/lyme's/EBV in 3/07 at the time I was also Dx'd for Non-Hodgkin's Lymphoma large cell B - central nervous system stage 4. I was given a very poor pronosis at the time I was finally dx'd (like a wk to live, having been misdx'd for a year w/ a "chronic sinus infect."). Anyway through God's good grace and an undeserved miracle, I survived the terrible chemo and mono-clonal anti-bodies at the U. of Chicago Hosp., been cancer-free; got HIV from sky-high to undetect., cleared HVB somehow, and am now in wk 28 of my Peginterferon/ribavirin therapy for HepC having had the "luck " to be genotype 2b, and having gone from a 9.5 million viral load to 1065 at wk 4, under 5 at wks 12, 16 &24. Incredibly, when I can get off this damned interferon, I've got a high prob. of curing the HepC and a "near normal life span" according to my (many) drs. When I was near death, the HIV dr. put me on Atripla and Ziagen ---for which I have been TOTALLY adherent. I got a new internist who's bd cert. in Infect. desease and treats AIDs patients nearly exclusively. She made the startling announcement that I must get off Ziagen immediately and start Isentress because I'll prob. get a high resistence to HIV drugs. I'm kind of a "if it's not broke, don't fix it guy" so I'm scared to switch, esp. since I read how Isentress is the last chance for many people for whom other HIV meds don't work. I want to keep Isentress "in reserve" My Ziagen prescribing HIV dr. said I can just stop taking Ziagen .... but I'm even nervous about that. Should I wait 2 more mos. till I'm done w/ the interferon therapy, anyway? Internist says "No." After all I've been through, you'd think I'd be inurred to it all, but I never had any real choices before this and I'm up a tree. Can you give any advice, please. (my CD4 is 95, but % are "great" (22), but that's normal for interferon therapy and all dr.s think I'll bounce back 52/m. Thank you very much!

Response from Dr. Young

Hello and thanks for your post.

Sounds like you've made a very heartwarming recovery and your future looks bright.

Assuming that you don't have any issues with baseline resistance, there's probably little additional benefit for you to be on a 4 drug regimen (ie, Atripla + Ziagen)- indeed, this issue was studied in a related earlier clinical study that showed with efavirenz (part of Atripla), there was no additional benefit to being on 2 vs 3 additional medications. In this regard, I wouldn't find that adding Isentress to your Atripla would be indicated and certainly worth holding in reserve for a (hopefully never) rainy day.

Now, that said, I might be inclined to wait until your interferon therapy was over with-- just an ain't broke, don't fix philosophy.

I hope this helps. Best of health to you,


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