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switching meds due to resistance
Sep 23, 2006

I recently found that I have become resistant to most Meds. My doctor put me on Kaletra, combivir and reyataz stating that there where no other options and things do not look good. My cd4 count is 673 and viral load in nodetect. What is the average length of time before these become non effective i have no idea how to plan my future and no one seems to want to give any real answer. should i know put away for the end do I have maybe ten years. what? could you please give me some stats for some one in my position so I have some basis to try to make the best of things.

Response from Dr. Sherer

Questions like this concerning people who are resistant to most ART medications are the most difficult to answer, because there is so much information that I would need to make a credible response. I will do my best with the information you have provided, and urge you to take your question and these observations to your doctor for further consideration.

Your case is unusual, because your values are quite good, in spite of the extensive resistance that your describe. It is unusual to see higher CD4 cell counts with complete suppression of the viral load to undetectable in such settings. So the first point to make is that no change is needed right now, and it is possible that your status could remain unchanged for many months, or even years, on your current regimen. I would ask your doctor to clarify the extent of resistance, because the single values that you cite suggest good susceptibility of your virus to this regimen.

You don't really want to know 'the average length of time' for a population, you want to know how long YOU can expect to remain well controlled before a change of treatment is needed. No one can give you this answer because there is no easy answer from clinical trials or observational studies that would apply to your single, complicated history; it could be as short as two months, and as long as two years or longer.

You and your physician can make some educated guesses over time as your observe your course on this regimen. Signs supporting long term durability would include continued suppression of the viral load below detection, and rising or stable CD4 cell counts, with no new symptoms of HIV disease, and no new or unacceptable toxicity from the drugs in this regimen. Signs suggesting that your current success would include a falling CD4 cell count, a rising viral load, or new or serious toxicities.

You certainly may have 10 years of quality life left, and you may well have twice that much or more. If you want your fortune told, go see a fortune teller. If you want good medical care, continue to see your doctor, and get a little more realistic about your expectations about the way in which he or she can help you. One thing you certainly should expect is for your physician to answer your questions, so write them down as they arise and take them to your next visit with you.

Finally, this is a bright era for people in your circumstances, i.e. with resistance to many or most current drugs. Several new drugs are available with activity against such resistant viruses, as well as new drugs that act on new targets in the viral life cycle. You should also talk to your doctor about these drugs. They include: 1) tipranavir: a new protease inhibitor (PI) that is active against multi-PI resistant virus 2) darunavir: also a new PI active against PI-resistant virus 3) enfurvitide: the first FDA approved fusion inhibitor that is administered by subcutaneous injections twice daily 4) TMC-125: a new second generation NNRTI that is active against NNRTI-resistant virus (available via compassionate access in the US)5) miraviroc: a new CCR5 antagonist that is administered orally that is available in the US via compassionate access 6) MK-0518: a new integrase inhibitor that will soon be available by compassionate access.


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