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HIV Drug ResistanceHIV Drug Resistance
          
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Resistant to it all
Nov 15, 2001

Hello, I just received news from my Doctor that my genotype testing showed that I have become resistant to all HIV meds. I came across this problem a couple of years ago and my doctor put me on five HIV meds including Kaletra, which is two in one. At the time, Kaletra was still being experimented on and I had to join a study to have access to it. My CD4s are at 187 and my viral load is at 75,000. My doctor says that both Sustiva and Kaletra can be salvaged, but he did not sound so sure when he was stating this and he had me do a second round of testing for risistance. I am concerned that I have no options left and I do not want to go back on a six-med conbination; last time I immediately saw lipoatrphy waiste my face away, along with various other health complications. Are there any meds up and coming? Should I think about a drug holiday, and is it safe to go on a drug holiday given that my t-cell count is so low and I have a high viral load?

Response from Dr. Little

It sounds like you are in a very difficult position. I would not be very comfortable personally about recommending a treatment interruption for exactly the reason you stated - your T cells are low enough that you could run into trouble fairly soon, and would then be advised to restart therapy. I do not think that the risks outweigh the benefits in your case to justify stopping therapy. That leaves you and your doctor with trying to come up with the best available therapy you can, based upon your resistance test results and your prior treatment history (and toxicities). There are some new drugs (Tenofovir - just released, T-20 - research and compassionate use, tipranavir - research study). Your best option if you are interested in finding out about whether there are any studies that you qualify for or whether compassionate use (provides access to drugs under very limited circumstances to people in need before FDA approval) is to ask your doctor or contact your nearest university HIV medical care clinic to get more information. Many community based organizations will also be able to tell you which centers in near you are doing studies with these drugs and then give you appropriate contact information. It may well be worth a few phone calls to find out if you have any other options before just going back to drugs you have already used and have clear resistance markers for. Good luck.


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