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HIV Drug ResistanceHIV Drug Resistance
          
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Drug Holiday-Wild Type Virus
Aug 9, 1999

Dear Dr:

I have failed on all existing therapies, the latest of which was T20 the new fusion inhibitor, while in a drug study at Hopkins. Apparently it acts like any single drug when added to a failing regimen. I have no other options available to me. My VL has returned to worse than T20 baseline of 141,000 with T cells at 129 and falling. I have consulted with many experts in person and online. No one seems to know what to do, but some have offered the possibility of a drug holiday for 6 weeks with genotyping and then restarting drugs. The hope is that the wild-type virus will be sensitive to the drugs again. I have been told the downside is a quick slide down without any drugs, but that, well that could happen anyway with no other options. I have not decided what to do, some have advised against it, others say its a long shot, but there is some documentation that it might work. While I decide and commit to such a course,I wondered if you had any thoughts or experience with this, and if so at what rate of success. Paul

Response from Dr. Holodniy

First, I hope when you say failed all therapy, that this failure was indeed defined by resistance testing, with expert interpretation that has clearly found multidrug resistant virus in you. If not, then that should be done. We have taken some people off all drugs based on multidrug resistance and ongoing toxicity from the current regimen. Wild type virus will reappear, but resistant virus will continue to exist in the background. I find that from a mental health stand point, some patients are relieved to be off a rigorous regimen for awhile. We don't know what the longterm consequence of this strategy will be. MH


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