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Resistance/Clinical Trials Question
Jul 24, 2001

Dear Dr. Little,

I wanted to tell you that you all do such a great job answering questions, helping others and teaching us all!

My questions are- if a treatment combo can only partially supress the virus in a person because of prior anti-viral treatment/ resistance, what else can be added to keep the CD4 count up until new anti-virals are available? IL-2 trials seem to exclude many patients with CD4 counts below 350, and prior OI's even if the OI is no longer active. Do you know of any doctors that are using IL-2 outside of a clinical trail in California for Arizona?

Thank you for your time!

Response from Dr. Little

Your question is a difficult one - that is, you may be able to improve the combination that you are on, based upon resistance data, to improve the level of viral suppression. If this cannot be done, then you have to balance the risk of continuing an incompletely suppressive regimen (and potentially selecting for additional drug resistance mutations while on this regimen) or stopping therapy while waiting for new agents to add to your available choices (and risking disease progression - especially if your CD4 cell count is low). This is a very difficult situation and I cannot provide definitive advice without knowing your complete history.

Regarding IL-2 trials in California or Arizona, I would use the web site: www.hivatis.org

I searched adult IL-2 trials and found several - many are ACTG studies and thus are more widely available. I would start here and see if you can find one that you qualify for. Alternatively, call your local university HIV clinic and ask them for advice on where/who to call for such a trial. You are correct though that many of these trials are restricted to individuals with higher CD4 cell counts. Best of Luck!


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