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Visiting: Is using a resistant regimen better than nothing at all?
Sep 15, 2013

Dear Dr Young, first of all I want to give my best wishes to the father who wrote for his son. Regarding this context, I would like to add few information and few queries. I heard about the salvage therapy with enfuvirtide. I dont know whether he was on T-20 as a part of ART or not. That might help along with newly emerged integrase inhibitors (even dolutegravir works for raltegravir resistant strains, while i dont have information regarding elvitegravir's efficacy in raltegravir resistance). Yes, I completely agree to your opinion regarding joining a trial with CCR5 inhibitors and newer maturation inhibitors. What about putting him into therapeutic vaccine trial as done by Sangamo/ Genetic immunity etc? He has a VL 4000 and CD4 450, which is not a very bad status in my opinion. These 4000 HIV in his blood is definitely escaping the already used treatments but one more thing is that he is on complera for 6 months, may be few months later it may drop down to more and might get undetectable with some kind of salvage therapy with newly coming molecules (T-20, dolutegravir, rilpivirine, etravirine, maraviroc etc) and experimental therapeutic vaccines. What about putting him in a trial with CCR5 genetically engineered CD4+ T cells? There is information regarding its initial success. Finally, I hope for the best for him and his family. I must say, dont be depressed. We all have fought it since 1980. Now we know the devil better and have plenty new molecules in the pipeline along with therapeutic vaccines. I would like to suggest him to be brave to join a phase 1/2 successful trial. Once you make it undetectable, I am sure the remaining virus will become susceptible to the older molecules (am I right Dr Young? Isnt it the story of natural selection?) Cheers!!!

Response from Dr. Young

Hi and thanks for posting your words of encouragement.

I agree with your assessment about trying different, and sometimes experimental strategies, though resensitizing resistant virus was once tried, and found not to be effective.

BY



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