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should I push for study drugs
Jul 25, 2000

My t-cell count is 220 and my last viral load was 6,700. I am currently on amprenavir.sustiva, norvir and ziagen -- I am waiting for new drugs be approved/ abbott 378 and pmpa -- My question is do you think I should try to get in a study -- for these meds -- I realize that I don't have much leeway with t cells near the danger zone of 200 -- I have also been looking at the Il-2 studies -- to boost my immune system -- any suggestions? I have tried all the approved drugs -- except nelfinavir and viramune -- which would be probably cross resistant anyway. I'm getting worried I don't like being in this situation. please help -- thank you

Response from Dr. Cohen

It is difficult to answer this one - but here are the issues.

We know that new meds are coming - and these meds can often be active despite resistance to many of the current crop of meds. So with your history and viral load of just under 7 thousand on these meds - we can assume resistance has happened within all three classes of currently available meds - nukes, nonnukes, and PIs. And while there is some influence of cross resistance to the new meds coming - they might still be more potent that some of the available options. So for example there might still be more potency to AZT 378, a new protease inhibitor, despite your current use of amprenavir/norvir. Unfortunately, there might also be some cross resistance, making it less than fully potent. So that is why your next regimen should combine as many new, and active meds, as possible - to help ensure that it is more successful, and therefore more durable. So therefore - the more new meds the better. And this means, that just having two new med options - 378 plus PMPA for example - still may not be as potent as needed if you instead had three, or even four new meds to start on.

So can you wait for even more new meds to get here or start on these now? Well, with a CD4 count of 220, you are still above the worry zone of below 200, and in fact the worry in terms of risk of illness doesn't really happen until below 100 so you still have some room. And we have noted that while on meds that are still only partially suppressive (still have a detectable viral load), the CD4 count tends to be stable for many months. So you have some time to wait. And a viral load of just 7 thousand is still pretty low and could remain there for a while. And during this time - other meds will get closer - like T-20 and others,

that could add to the viral suppression.

A resistance test might help here as well - since it could help to identify which of the available meds might still be active when you need to create this new combo. And which ones aren't doing much of anything.

As for IL2 as a boost - there are world wide studies going on to address exactly your question since we are still uncertain what to do with that drug in this type of circumstance. It might help to increase the CD4 count, and it generally does so with only a temporary increase in the viral load. But there is controversy about this one and so that is a discussion to have with those who are working with you - IL2 can have some significant side effects for example.

So you have time - and options. And at least for now - PMPA isn't easily available - so most of us would not just add the 378 at this point. You need that next hit to work.

good luck.

Cal Cohen, M.D., M.S.



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