Apr 9, 2005
Hi I feel that I am at a crossroads with my treatment. First, let me say that I have gotten great care. I just happen to be one of the unlucky who has developed resistance to most everything I have taken. I was diagnoised in '93 with 170 tcells. I was started on azt and ddc and then on to other meds when the meds weren't satisfactory. Knowing what we know now, we never would have switched meds so often. I should point out that I am on e of those patients who never misses a dose, I work out and try to stay active.Even after moving from med to med my tcells stayed at around 300 an d my vl would be about 20K. Phoentype tests were run often to plan out the best salavage therapy. Latley my health and numbers have been declining. My cuhat rrent Dr is anxious to get my T-20 and also tipranavir. I did see a specialistat UCSD that would like me to wait and enroll in a new study for a integrase inhibitor -as well as the T20 and tipranavir. My only problem with this is that I contimue to slip and worry I might not be around for this great treatment. The trial is supposed to start in 4-8 weeks. By the way, my current cd4's are 60 and my vl is 180k.What is your opinion. thanks
Response from Dr. Sherer
I just answered a query with a similar story. This venue does not lend itself well to the most complicated situations like yours, i.e. with complex treatment and resistance histories. Your best bet, in light of the excellent care that you have received, is to trust your doctor(s). I'll make some suggestions, but please be aware of their limitations; only your doctor has all the data that is needed to consider such cases.
As in the previous response, I agree with your doctors that the best way to use tipranavir is to add Fuzeon (i.e. enfurvitide or T-20) to it. The results of the tipranavir registrational trials clearly showed that the best results occurred with this combination, in addition to the best selection of NRTIs with partial activity. More than half of patients had good responses after 24 weeks in this setting.
I also agree with your doctors that the integrase inhibitors, as well as the next group of entry inhibitors, appear promising, and that they might add additional antiviral activity, if they are available.
But the question I can't answer for you is the issue of timing, and the risk of a wait for 4-8 weeks. Certainly I would want a prompt decision and initiation of the next regimen, but you and your doctor will have to weigh all of the evidence and make that specific judgement in your case.
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