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Fuzeon as next option?
Jul 9, 2004

Hey there, I don't expect a definitive answer to this question, but i'd just like some advice, maybe pros vs. cons. I have been HIV+ for 16 years so i'm pretty heavily resistant to all meds except Fuzeon. My cd4 count has been in the single digits for the past 13 years or so. Other than that, no major opportunistic infections, just thrush on occasion. In the past year my viral load is hovering around 50,000-80,000 and my cd4 dropped to zero. I wouldn't really be concerned, but i've broken out in very severe psoriasis. My ID doctor, who worked with HIV in the 1980's, says psoriasis used to gauge viral progression before viral loads could be obtained. A study in san francisco 20 years ago found that most HIV patients who developed psoriasis died within 1 year of its appearance. He suggested I try fuzeon. I got approved for it but i am still not sure if i should take it. I'm a hemophiliac, so the injections could cause internal bleeding. I also would hate the hassle of reconstituting it. My biggest concern, however, is resistance. I have heard Fuzeon works poorly as a single agent. I know you don't have my genotype and phenotype in front of you, nor can you possibly make an informed decision from a short letter. They'd put me on other medications in the hope that they'd do some good (which is my situation right now, phenotype shows poor results with all meds, but i'm on viread, epivir, and viramune trying to remain stable.) So anyway, after this extremely long e-mail, here are my questions: Will using fuzeon now as a temporary solution leave me without any treatment options in the future? Will that in turn make my long-term survival less likely? I have lived forever with poor cd4 counts and a viral load that has never become undetectable. I don't feel anymore "sick" than i ever have before. Would it be better to wait until new drugs came out and a cocktail became viable? My doctor warned me not to wait until it was "too late," at which time no amount of medication could reverse the damage. When is too late? Could it really happen that quickly when i'm on profolaxis for PCP and MAC? Also, what is the meaning of life? Thank you so much for your time.

Response from Mr. Kurtyka

Your scenario is pretty common (except the Hemophilia part). I would be reluctant to add Fuzeon as essentially the only true active drug as resistance would definately be more likely to develop quickly. Like other agents, you want to try and have at least 3 active drugs on board.

Do you have access to any clinical trials? Not knowing your resistance patterns, maybe you could get into a tipranavir study, TMC114, TMC125, capravirine, others? It could be that your current regimen is keeping your replication capacity at a lower than wild-type level and helping to maintain a pretty steady VL range of 50-80,000. If this is the case, maybe you can continue on your current regimen while waiting for at least one or two more new agents to put into the mix.

What is the meaning of life?? --- I think that's on one of the other boards :)

--dk


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