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Re: Dosage Questions
Oct 12, 2001

Thank you for answering. It is reasuring that the 2x and 1x dosages currently in use are showing long term durablity. Unfortunately we dont yet as you pointed out have complete evidence that the 4durg combinations work better than the three, my hunch is that they will be. However as you pointed out it would I think be best to begin usuing them once we have worked out problems of dosage and pill burden. If people are having problems adhearing to a 3 drug 2x regimen why would they not have problems adhearing to a 4 or 5drug 2x regimen which would be even more burdensome. I am hopeful we can eliminate those difficulties and get 4 or 5drug combinations down to low pill burden 1x daily dosage and then put them into the hands of patients. What do you think? As far as Atazanavir(BMS232632) do you think it will be approved in 2002 or will it have to wait til 2003? I have noticed that Tenofovir has been approved, but only for persons who are treatment exsperienced and who have resistance. What is the possibility of this being used by treatment niave patients? Why would it not be wise to include this in a combination for treatment naive patients? Unless they are wanting to perserve its use and avoid widespread resistance to it in naive patients? I have been asked a good question by a college professor maybe you could answer this one as well? Most of what I am hearing is that a person who is infected in 2001 right now and who is compliant with his/her physicans instructions and adhears to the dosage schedules of thier medications, is that there is no reason to suspect that person would not be able to live a normal lifespan. Today the average life span is approx. 77-80yrs of age. This would mean 35-50 years of treatment for the average patient. Do you think this is really possible or not? I am hoping you do! Finnally a last question there has been a lot of talk of something called the "Hemopurfier" lately. Its manufacture at thier website "www.aethlonmedical.com" says it can clear up to 90 of circulating HIV from whole blood and plans to test it in human trial as a "Entry Inhibtor" . My question is this IF it can do this and does clear 90 of circulating HIV from the blood of a patient, would this be really usueful? On one hand I think maybe on the other I fear it is not going to make any real diffrence and wanted to hear your thoughts as IF this worked it could be a great benifit to those infected who have trouble with thier meds? But since I have found it mentioned no where on this site it does make me wonder about its usuful potential. I thnak you again and look forward to hearing your responses. Thanks Brian.

Response from Dr. Boyle

Wow, you have a lot of questions, don't you? First, until it's shown that 4 or 5 drug regimens are better than 3 drug regimens, I think we should concentrate on simplifying and improving the effectiveness of 3 drug regimens. Studies indicate that most of the 3-drug HAART regimens used today, especially those that involve Kaletra (lopinavir/ritonavir) or Sustiva/Stocrin (efavirenz) are extremely potent, durable and well tolerated. At this point, I am not sure that adding a fourth drug to a naive patient's regimen does anything except increase the pill burden and the potential for side effects and toxicities. Of course, more complicated regimens, with more drugs, may be needed in pretreated patients, but that is usually required because of underlying resistance, which in many cases arose because of nonadherence to complicated, difficult regimens the patient was previously on. Atazanavir will likely be approved in late 2002 or early 2003. Viread (tenofovir) has not yet been approved but it is likely that it will be in the next few weeks. Even if it is approved only for use in experienced patients (the FDA panel voted 9 to 7 in favor of this), once approved, physicians and patients can use it as they see fit. I think it may have a great deal of use as a firt-line agent and may be very effective at simplifying regimens since it is one tablet once a day with low side effects and toxicities. Yes, I think most patients infected today will be able to live normal lives with relatively normal lifespans, but they may need to be on medications all of their lives. Given the potential side effects and toxicities of the medications, and that they don't work in everyone, uninfected persons should do everything they can to remain that way, otherwise they may have to be on pills for the rest of the lives. Finally, there is no evidence that a hemopurifier, whatever that is or means, does anything for HIV disease.



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