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New One Pill a Day
Jul 21, 2006

I am currently on salvage therapy because of being resistant to almost all of the HIV.

I am currently on Fuzeon a Aptivus, and truvada boosted with Norvir.

My viral load initially went from 450,000 to 50,000 then down to 600 but then started coming up and now is at 25,000. I have missed a few doses of Fuzeon over the course of almost a year on it. I did well the first 3 months until the injection site reactions were so painful that I could not inject and missed one or two doses a week. I got on the Biojector study and was doing well the first couple of weeks then the injection site reactions even from that were so severe that I kept alternating between the needles and the biojector.

I just had labs drawn but haven't seen them yet and I am concerned that my viral load will be even higher. I would like to think that the new 1 pill a day would be a good idea but the only problem is I am resistant to Sustiva and I was told once you are resistant to sustiva you are resistant to all 3 drugs in that class.

I am wondering if that has changed and if a genotype might some some septability to sustiva and the new one pill a day may be an option for me.

I am at my wits end trying to cope with the fatigue of enduring the pain from the injection site reactions and it is causing me to miss more doses than I should.

Thank You,

Loyd

Response from Dr. Daar

Hi Loyd, Thank you for your posting. You raise several very important points.

First of all, the new one pill per day is an important advance but unfortunately is not for everyone. In fact, it is primarily for those with very limited or no drug resistance. You are correct that if you have been resistant to sustiva in the past it is unlikely that you will derive much benefit from including it in future regimens.

It sounds like your viral load has not been undetectable after several months of your current regimen. Based upon this you should discuss with your provider a strategy to start considering the potential role of new drugs, such as darunavir which has just been approved and even a regimen with drugs that may be available in the not too distant future such as CCR5 inhibitors and/or ingetrase inhibitors. In the meantime it sounds like the T-20 injection sites are very unpleasant and impairing the quality of your life. The reality is that at this point you may be experiencing all the disconforts without deriving much in the way of benefit. It turns out that if viral load is not suppressed on T-20 resistance often occurs. You should discuss with your provider whether s/he feels it is important for you to remain on this treatment. It is even possible to do resistance testing to verify whether this is currently an active agent for you or not.

Best, Eric


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