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maeby changing medication
Jun 12, 2006

Dear Doct. I am in one country where is very difficolt to by any medication,In the last 7 months my cd 4 drop 300, the reason is I was very sich Cough fever infection on trouth, neo I filling little better, I have one test about 4 days go and my cd 4 drop one hundret, my doctor said maeby I am resistance on my medication I am on Lamivudine and stamivudine and sustiva, we must import sustiva because is not avaible, in cause I am resistane and looks I must import medication what type of medication we can suggest please? or other way is to finisch with this world! I can give you viral load test because is not machine avaible,m the only way is to go to thailand. Thank you in advance By Tom

Response from Dr. Sherer

You are right that a second line regimen is needed, if your CD4 cell count fell from 300 to 100 while you were taking your current regimen, and you have been feeling sick.

The best second line regimen would be a protease inhibitor, preferrable boosted with ritonavir, and one or two new NRTIs. Options in your region may include lopinavir/r (Kaletra) or saquinavir (Inverase) plus ritonavir, for example, with either abacavir (Ziagen) and didanosine (Videx) or lamivudine, or with tenofovir (Viread) and lamivudine. There are other viable options as well, as per the US HHS Guidelines and the WHO ART Treatment guidelines.

If available, the choice would be informed by a genotype test - but the above options are reasonable in the absence of a genotype.


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