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The Roche T20 Trial
Apr 29, 2001

Dear Susan, Not sure if you are the one I should be talking to but I am first in Australia to be offered to Roche as a trial candidate for T20 . It will start hopefully soon. My T cells vary a lot but are down to 120 and VL to 370,000- I thought that wa shigh until I heard of others around 800,000! How successful has T20 been? I have heard from some that it is excellent for many while some say it has done little for them. I am resistant to most therapies to date except the old favourite AZT which I took almost 15 years ago.

Response from Dr. Little

In most people, the consequences of acquiring drug resistance over time become worse as the number of drugs to which you have resistance increase. Regarding T20, the data that I am aware of showed very good reductions in viral load, but this study was among people who had never before received one of the major classes of drugs, the non-nucleoside reverse transcriptase inhibitors (such as efavirenz and nevirapine). That is, these patients started T20, with other new antiretroviral medications and had good short term responses to the therapy (I have only seen short term data presented, but believe that follow-up continues and more data will be presented when available) compared to those who took the best available antiretroviral therapy they could select without T20. As with most new drugs, I expect that the responses will be best among individuals who still have something to combine the new drug with. If you have drug resistance to all available antiretroviral drugs and are starting T20, you may still have a response, but I would not expect it to be as significant as someone who had one or two or three other new drugs to add at the same time. Although this may sound bad, there is still quite good data to suggest that there are ongoing benefits to therapy compared to no therapy among patients with more advanced HIV infection. So, I think that T20 sounds like a good idea, and you and your doctor should look closely at your previous therapies and drug resistance test results to try and add with T20 other antiretroviral drugs which you are most likely to have a response to (even a partial response) and then follow your viral load and CD4 cell counts on the new therapy. Most of the side effects of T20 have been limited to the injection site reactions which seem to occur in about 2/3 of patients, but have not in general been serious. Good luck.


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