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Is using a resistant regimen better than nothing at all?
Sep 9, 2013

Dear Dr. Young, We are desperate. My son is out of options for HIV meds. He is either resistant to them or can't tolerate the side effects. We have several drs. we are working with. In your opinion, would it be better to put him on the complera which he can tolerate than having him on nothing at all. In 6 months time on complera, his vl was 4000, and the cd4 was 450. He was diagnosed in 1995 with a vl of 770,000 and cd4 of 34. After this many years, we have been through all regimens possible. Please help me to make a decision. Our drs. are telling me to have him in palliative care, and he is in good health physically but not mentally. I am certainly not ready for this. Thanks so much!

Response from Dr. Young

Hello and thanks for posting.

Sorry to hear about your son's difficulties. You raise some important questions- ones without definite answers, but strong opinions. So here are mine.

First, it's really important that people living with very highly drug resistant HIV receive care from experts in drug resistance. This isn't every provider, and often found in large academic centers. It takes a very careful analysis of the virus' entire treatment and genetic background to try to construct a best treatment regimen. Until this has been done, I wouldn't necessarily conclude that there's no treatment available.

Next, in general, it's better to be on even a partially suppressive treatment than none at all- the risks of this are side effects and the possibility that the virus will develop even more extensive drug resistance.

It's also worth having an understanding for what new drugs are in the pipeline. This used to be the safety net for many of my patients with multidrug resistance. I'll also use all available diagnostic tools to look for what drugs might have potency- I refer my patients (or their families) to the free Stanford HIV Database, understanding that some drugs (especially integrase inhibitors and CCR5 inhibitors) don't typically get resistance testing.

Last, while I'm a big fan of having palliative care evaluations in people with chronic illnesses (and this is done far too infrequently), with your son's CD4 count in the 400s, it seems like his immediate health is pretty good.

I hope that helps and please feel free to write back. BY

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