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Going off Protease Inhibitors
Jun 26, 2001

I am in a situation, like many, where the protease inhibitors are not really working for me very well any more. My T cells are at 300 and my viral load is at 29,000. I am a long term survivor (ten years) who was diagnosed with AIDS as a result of Lymphoma (believe it or not I am still here!). The protease inhibitors are causing more side effects than I believe they are worth. My doctor has the balkanized (albeit warranted) attitude that if I do not take the cocktail then I take nothing at all. I lived for many years without the protease inhibitors (before they came into use) why can't I now? I don't want to take nothing as we all know what that will lead to but I just don't want to take the protease inhibitor as part of my regime. Is there such a thing as a cocktail without the protease?

Michael

Response from Dr. Young

Thanks for your question.

It certainly sounds like you have evidence of viral resistance to your current treatments. An important decision at this point is whether to continue on therapy (with a treatment switch) or to discontinue therapy.

I probably wouldn't recommend staying on your failing regimen; this would only place you at increasing risk for high levels of drug resistance and increased risk for cross resistance among the drugs of the same class.

Stopping therapy would have the advantage of reducing the risk of resistance and eliminates the side effects of the drugs. Stopping therapy might cause you CD4 cells to decrease placing you at risk for other complications; this risk and short-term benefit have to be weighed and balanced for your individual situation.

There are very likely treatment options for you that either include using other protease inhibitors or the use of non-nucleoside RT inhibitors (non-nukes). The choice of which drug to use again would depend on the resistance pattern of your virus and the side effect profile, pill burden of the future regimen.

Good luck, BY



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