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Dr tells me: Few options avail. result of inconsistent compliance.
Apr 29, 2001

Hi,

I have been taking a combination of Viracept, Zerit and Epivir for 2-3 years. My current T-Cell count is 480. viral load 11,000. I have been HIV+ for 14 years that I know of and have been asymptomatic . Previous medications have been AZT, DT4, videx etc. I recently had genotype testing and my Dr indicated that as a result of my difficulty with compliance, the genotype testing indicating a high level of resistance. In addition she advised me that as a result not many avenues are available at this point, but we will explore this further. I live in MA-Western, am fairly well informed and would like to know about any new drugs or treatments that are available to respond to high levels of resistance. I also am concerned as I work full time but drive alot about how a change in treatment therapies may impact on my ability to function effectively at work....I do lots of driving and am concerned about GI problems in relationship to lack of restroom facility access. Your response(s) to my conerns and questions will be helpful....thank you.

Response from Dr. Little

The answer really centers on whether you have a "high level" of resistance to all available drugs or to the drugs that you are taking now. If you have failed most of the available drugs (including the other protease inhibitors), then she is correct and the options become more limited. If you have a high level of resistance to nelfinavir (Viracept) and the other drugs you are on, but have not taken other protease inhibitors or non-nucleosides (ie nevirapine or efavirenz) then you may have many choices. There are quite a few options now and it may be possible to come up with a regimen which is still quite effective. Regarding interference with your lifestyle and job, this may be an issue, but unfortunately at some point, you may have to modify your schedule (perhaps only temporarily) to maximize your chances of the best possible outcome. We do not have many drugs that do not have associated side effects and we as physicans do our best to try and help our patients work through these, but we cannot prevent them entirely.


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