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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
          
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How many ?
Aug 22, 2004

I heard there are only 3 lines of treatment are avilable for someone who is positive. Is that right? When do you think the once a day medication will be available in Canada?

Thank you

Response from Dr. Conway

Once-daily treatments are already available in Canada. Of the commonly used drugs, only zidovudine, stavudine and nelfinavir cannot be used once a day. And for nelfinavir, a new more convenient 625 mg pill will soon be available in our country, making it much easier to take.

As for the number of lines of treatment that are available, this is a complex question. If there is true virologic failure with each line of treatment, then it will be very difficult to design more than 3 lines of treatment that can lead to virologic suppression. However, there are a number of strategies that could be used to maximize the potential long-term benefit of HAART, and avoid the risk of virologic failure. First, the initial regimen must be carefully selected to promote adherence to therapy and minimize the risk of side effects of the type that would most affect the individual who will be taking the pills. Then, if side effects develop, it is important to address them assertively, considering single drug switches in the HAART regimen to control toxicity and maintain efficacy. Finally, if virologic breakthrough on therapy does occur, it is important to consider switching to a new regimen sooner rather than later (especially at the time of first regimen failure) to limit the accumulation of multiple resistance mutations. If these principles are followed, it is likelier that the efficacy of HAART can be maintained indefinitely.



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