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HIV Drug ResistanceHIV Drug Resistance
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Undetectable for years: what's happening now?
Dec 31, 2004

I first tested HIV positive in Feb. 1987 and I have been well since. No problems except lipodystrophy, for which I had some surgery this fall. My viral load has been below 50 for the past several years, but I just got the results of the most recent test and the VL was 172. Intellectually, I know it's too early to be concerned, that I need to look at a subsequent test. But I just need to know there is something else waiting for me in the drug pipeline which will keep me from sliding into bad health. I have always taken my drugs faithfully; for the past couple of years they have been Reyataz, Emtriva, Norvir, and Viread. Before that, Crixivan, Epivir, Zerit, and before that, AZT. I've taken a lot of drugs in the past (almost) 18 years. The most recent labs, by the way, showed T-cells above 500 and percentage at 28. In case the viral load is not just a blip, are there some other drugs waiting? Thank you for your time and help.

Response from Dr. Sherer

You are right, it's premature to go looking for your next regimen at this moment, as this single value may represent a blip. Stay adherent to your current regimen, and wait for your next values. Nonetheless, here are some preliminary answers to your questions for your information.

There are other drugs in the pipeline for patients with multiple resistance mutations - though I can't say that you are in this category from the information you have given me.

The newer PIs, such as lopinavir/r (Kaletra) have activity against viruses with some PI resistance mutations. And among the NRTIs, abacavir (Ziagen), tenofovir (Viread), and didanosine (Videx) may have activity against viruses with some resistance mutations.

For patients in whom regimens with the above agents have failed, there are also alternatives. Tipranavir, the newest PI, has activity against viruses resistant to most current PIs, and is available by compassionate access.

And T-20 (Enfurvitide), the first entry inhibitor, acts at a novel site in the HIV lifecycle by blocking viral entry into the cell. It has been shown to offer substantial benefits to patients who are multiply resistant. It requires twice daily injections, and about half of patients have some injection site reactions such as itching and redness.

How important is "undetectable?"

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