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HIV VL - Should I stop and wait for new drugs?
Sep 22, 2006

I Started to Duet study 3 and a half months ago. (drugs: TMC 114, Fuseon, Truvada, DDI (250), and 50/50 chance of getting tmc 125). I'm highly treated, but had never been on Fusion. Starting t-cells, 110, VL 125,000. After 2 months, I went undetectable, t-cells 242. I got my 3 months results upon returning from the Intl AIDS conference, (heard your presentation during the health management session, which was great), but learned by t-cells were 238, but VL 1210. I havn't been sick prior to the test, and have been 100% adherant. My greatest concern is about resistence setting in, particularly for Fusion. There are few other treatment options avialable if this fails...(I'm already dual-tropic, and the maturation inhibitor seems to be taking its sweet time, etc..) My strategy: We're having the test redone in a few days in two separate labs (unfortuntely I got a cold coming back from Toronto). If I still show a viral load increase, immediately go back to my previous 5 drug regimen (Keletra, Epzicon, etc), and wait for Mercks integrase inhibitor to go into expanded access in a few weeks, then restart the Fusion/114/Truvada with it. In the meantime we may check for resistence to Fusion. I fear that if I don't make it through this, I may not make it through to the next round of drugs. (I've been HIV+ for 20 years, AIDS for 14) Does this stratgy sound good, any other suggestions/comments? Thanks

Response from Dr. Daar

You have obviously done your homework and an outstanding job of advocating for yourself and becoming informed on all of the issues. I completely agree with you that another laboratory test is needed before you can be sure that your viral load will not return to undetectable levels. If it continues to be increased I would encourage you to discuss your options with your provider as well as the study team. You do want to maintain options for the future and you are correct that the drug at greatest risk is fuzeon (T-20). If your viral load is elevated I think your plan is a good one. I would suggest that before changing meds you send a resistance test and if possible include testing for resistance to T-20. This information may help you make treatment decisions in the future. If you are defined as a treatment failure in the current study you should eventually have access to whether you were on TMC 125 (etravirine), which may also provide useful information for how to design your next regimen. My guess is that with the very good response you had to your current regimen the future addition of an integrase inhibitor should have a high likelihood of success in suppressing your virus.

Best, Eric


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