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HIV Drug ResistanceHIV Drug Resistance
           
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Salvage Therapy
Apr 3, 2005

What would you advise a patient with resistance to PIS and NNRTIs, cryptoccocal meningitis, CD4s of 8, a Viral Load over 100,000, off therapy for six months because of wasting that may have been caused by meds?

weight returned from about 129lbs. to 160lb after stopping Crixivan, Kaletra, Combivir, Viread.

Resistance to all usual antivirals, Protease Inhibitors and Fuzeon.

Diflucan is no longer effective. Vfend (Voriconazole), also not effective.

Taking Valcyte(for CMV), Bactrim and Acyclovir. Also taking injections of Neupogen, anddaily infusions of Ampho B. Kidney labs bad.

Response from Dr. Sherer

I would recommend that you get together with your doctor and talk about all of your options, including the few suggestions that follow. You should understand that this answer is incomplete, as I don't have all of the information that I would need to give you an informed opinion.

Tipranavir is a new PI that is available for patients in your situation on a compassionate release basis. You should talk to your doctor about this new drug, and the possible other drugs to which you may have partial susceptibility that might be paired with it.

There is evidence, for example, that even with Fuzeon resistance, a second use with tipranavir provides some extra benefit.

Common NRTIs for which some residual use may be possible, even with some resistance, are DDI, abacavir, and tenofovir...though the latter is difficult to use in the presence of kidney problems.

Another consideration is the maintenance of partial therapy, if there are no satisfactory full regimens that you and your doctor can identify. There is a survival benefit to remaining on HAART as compared to stopping altogether, even with drug resistance.

Unfortunately, the new classes of drug, such as the other entry inhibitors, are not available now, and unlikely to be for another year or two.

As above, I urge you to talk about all of the possible outcomes for you at this time with your doctor.


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