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Failure on T-20 and Tipranavir
Jul 4, 2004

I have been using T-20 and an experimental and as yet unapproved PI called Tipranavir along with Viread, Abacavir, and Epivir. When I started at the beginning of March my T-cells were at 8 and my viral load above 87,000. My t-cells rose to 21 then fell to 12 and again to 11. The viral load has gradually gone down from 87,000 to 63,000 to 21,000. My doctor basically considers this a failure and told me to consider switching regimens once again. I have been on meds since 1995 with little success from any of them. I guess I feel a bit hopeless about taking meds. My doc has already said that any new regimen would not work any better than this one has. Should I continue placing faith in drugs which never seem to work?

Response from Dr. Conway

You ask a difficult question. I would probably do a resistance test (a phenotypic test for you may be best, given how complicated the genotype may be). If, based on this, a regimen can be designed that may lead to virologic suppression, you may consider this. If not, it may be that the best thing to do is to go on a regimen of just nucleosides. Deeks et al have shown that in this setting, this type of regimen does lead to some benefit prventing too much deterioration in your clinical state while awaiting new medications, such as new entry inhibitors and 2nd generation NNRTIs that may become available later this year in expanded access or clinical trials. But I would encourage you to look at the resistance test result first to see if there is any regimen that could be designed that would work better for you.

Good luck...



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