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End stage?
May 10, 2012

End stage?

Dear Mister

I am HIV since 1996 and I live in Venezuela. Currently, I have multiple resistance. I had my last therapeutic failure. Also, I am resistance (proven) to darunavir (prezista), truvada, raltegravir (Insestress), Etravirina and also, T-20 (Fuzeon). At the present time, Cd4: 70, index cd4/cd8: 0.26, CV: 121.972 copies, log: 5.08.

As a result, the Venezuelan Resistance Comitte recommends an ideal therapy to me that contains (transcribed): Dobultegravir, Maraviroc (T Tropism proof prior and just if I could use it), Etravirina and possibly Darunavir/Ritonavir (for not leaving it without IP); in this case, this therapy will add two actives (one of this is a new mechanism of action) and two other very affected medicines that could help the others. However, at the present this is not possible because Dobultegravir has not been approved by the FDA and Maraviroc is not available here in Venezuela yet.

As a recommendation, they propose a scheme of containment using Truvada, which they have been providing me since two months ago waiting the arriving of the new medicines. However, Truvada is causing me kidney and liver problems. In adittion, I think that taking only Truvada is not working for me, I continue decaying more and more each day and I think will not be able to support the arrival of the new medicines.

Reciently, I was hospitalizad with Neumocitis Carini that attack to me in spite of being taking bactron (trimetropin/sulfametazol). I was very bad in such a way that in the medical history, the doctor wrote: "in End Stage"

I contacted an Expert in Resistance (he is not a Physician) from Spain on the Internet and he suggested me two different treatments:

1.- The first option is: Rayatax, Raltegravir and truvada without ritonavir. He said that it has been observed that this treatment stabilizes cd4 and decreases the viral load despite of resistances.

2.- The second choice: Raltegravir, Truvada and Intelence because it has been observed the stabilization of the disease with this combination in spite of also having resistances.

Both options also include Aciclovir (3 times per day), deca durabolin and testosterone 200mg per week in order to prevent weight loss.

What do you think about these combinations or treatments for my specific case?

I am looking forward for your answer. Thanks

Best regards,

Carlos

Response from Dr. Henry

There is no good data on how to best handle your difficult situation short of utilizing at least 2 active drugs along with optimized back ground regimen. I would try to find out when drug may be available in at least a compassionate basis in Venezuela. I would hesitate to burn through other drugs-for now would optimize prevention of opportunistic infections and nutrition/hormone levels. I am very sympathetic to your situation-in the US we can get dolutegravir on a compassionate basis (called an expanded access program even though it is not approved in the US by the FDA). Have you had a local HIV expert to see if dolutegravir can be made available in Venezuela on a compassionate basis.KH



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