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New BMS Drug
Aug 25, 2002

Hi Dr. Cohen, currently I am reistant to all meds-except tenofovir and I have some sensitivity to saq. My last regime was 100mg rit bid, amp bid, and trizivir bid. I was on that combo for 3 years. I read where the new bms protease inihitor may be effective for those who have resistance to amp. I am wondering if you feel this is true. At this pt. the only effective med I am taking is tenofivir-I am afraid that I will lose that soon if I don't replace my salvage protease inhibitor to saqiunavir.

Response from Dr. Cohen

There is some interest in the new BMS PI called atazanavir -- but so far there is little information to truly know if it will offer any advantages over your current combo. It is possible it could be added to saquinavir - one study did just that. It did about as well as the combination of ritonavir plus saquinavir however - not better. And for those with multiple mutations in the protease gene it is not so clear that this new PI offers an advantage. But the study to answer this is underway - and we should have the answers soon. Until then it may be worth a try - since any combo shows it potency in the first month on it, so you'd know pretty soon if a new combo of atazanavir/saquinavir works better than what you are doing now.

However, in the longer term there are new meds coming with more promise for those with lots of drug resistance. Closest to available is T20 - a completely new medication that can work well when added to a potent combo. Further back in developement is a new protease inhibitor called Tipranavir - this one may be more potent that atazanavir in controlling resistant strains. It should enter larger scale trials in the US in the next several months.

One of the toughest questions in HIV management is knowing when to make the change when the current combo isn't working well, and there are not 2-3 new potent drugs available to change to. Some people have ongoing viral loads - and stable enough and adequate Cd4 counts to hold out so that the pipeline can fill up with enough new options to make the next change more successful. Others need to move sooner... and for them there is more uncertainly - but as you said, sometimes you need to move on to protect the current meds from even more resistance. You don't mention your current viral load nor CD4 count - and sometimes it is this info that is most helpful in judging what to do and when to do it...

Good luck. Hope this helps.



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