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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
          
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Naive but bad genotype. Which combo ?
Dec 14, 2007

Hello,

I would like to thank you for your forum, which is very helpful !

My question is the following:

I have probably been infected Q4 2006 and discover it on Sept 2006. I have no symptoms in the exception of swollen lymph nodes. The PET-scan showed a focal point in the right adrenal gland (susceptible to be related to a lymphoma) but a biopsy will answer to that question.

My last count where: CD4 = 595 17.2% VL=4700

The genotype I made recently showed the following mutations:

NRTI: M184V T215FIST

NNRTI: K103N V108IV

RT: T39N S48T V601 K122P D123E I135M S162C D177E G196E Q197K T200A Q207E R211K L228R

PI: T12S I15V G16E L19I M36I L63T H69K 172IV I93L

As such, all the NNRTI class is highly-resistant, part of the NRTI, but have access to all the PI.

I saw my ID Doc which advised me to wait till my CD4 count reach 350 after 2 measurement made a 6 weeks of interval.

He proposed me the following combos:

1) First line treatment Invirase (saquinavir, SQV) Kaletra (Aluvia, lopinavir/ritonavir, LPV)

2) 2n line Isentress (raltegravir, MK-0518) Prezista (darunavir, DRV) Selzentry (Celsentri, maraviroc, UK-427,857) maybe for 4 years

Questions:

1)Would you recomend this lines of treatment ?

2) What about Kaletra + Reyataz ?

3) How long time may I expect to stay on PI only (first line) and with the second line ?

4) Will these treatment be efficient against my mutations ?

5) What will be my options once these 2 lines won't work ?

6)What could be the average life expectancy

7) I have been infected by my ex-girlfriend. I never saw her taking any drug. Does these mutations suggest that she was on HAART ? It won't change anything knowing that but will let me know if she was knowing his status or not.

Thank you so much for your answers. Thank you.

John

Response from Dr. Henry

Good questions. We don't yet know the best manner/order to use the new Merck integrase inhibitor raltegravir, the CCR5 inhibitor maraviroc, Fuzeon, and etravirine (NNRTI active against R virus now available in the US through expanded access program). Generally using 2 active classes results in a high degree of success. The goal should be to fully suppress your virus when treatment is started in order to not lose the effectiveness of any drugs. Prior to the availability of the newer drugs I often had reasonable success simply with double boosted PI based regimens (often Kaletra _ saquinavir or atazanavir). Waiting until we know more about how to use some of the new drugs (as long as CD4 count > 350-400) is a very reasonable option. If I were to treat I would likely overtreat (induction) with something like aDarunavir/raltegravir/etravirine based regimen and then consider pealing off a drug if doing well and more data available from studies that such an approach is safe/effective. Is your strain a su-type B or other strain? Prior to starting Rx you may want to get a Trofile assay (tropism) if that is available to you (to check for activity of maraviroc). Getting a phenotype test may also be helpful to sort out the best background regimen. Your ex-girlfriend needs to have her HIV status including resistance status if indeed HIV+ assessed by an HIV specialist. KH



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