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Whats next?
Dec 9, 2006

Being positive since 1992 my t-cells have never been over 250 since starting treatment at t-cells of 7 for 2 years. For the past 7 months I haven't taken any HIV meds do to resistance to everything. Last t count was 42. I can't handle Novir, so anything with that I can't take. Any precautions I should take besides the flu shot.Why are drug companys so slow at proving new drugs to take?

Response from Dr. Daar

Thank you for your post.

Needless to say, the situation you are in is complicated and to fully respond one needs to know exactly what your T cells have been, your treatment history, which medications you have or have not tolerated in the past and any drug resistance tests that have been performed. There may well be strategies to use that would maintain your T cells at a stable level while awaiting future drug options, for which there are many in the pipeline. You may still benefit from being on some medications at this time even if there are not enough available to fully suppress your virus. In any event, you do need to make sure you are working with an expert provider who can review all of these issues with you and discuss options for now with a plan towards the future when you might have access to expanded access drugs such as integrase inhibitors, a new NNRTI called etravirine (TMC-125), either or both of which could be combined with T-20 (enfuvirtide, Fuzeon) if you have not developed resistance to this drug in the past. The good news is that some if not all of these drugs may prove to be active for you and none of them need to be given with Norvir.

You bring up a very good point, that being what else can be done to stay healthy while waiting for the right antiretroviral regimen to become available. In general we do recommend vaccines against Hepatitis A and B if you are not already immune. In addition, immunization against pneumococcal infection and the flu is appropriate. With CD4 cells below 50 you should discuss with your provider what medications you should be on to prevent infections, most notably PCP, toxoplasmosis if you are at risk (which your provider should be able to tell you) and MAC. Add on to this the importance of good diet, exercise, avoiding tobacco, excessive alcohol use and illicit drugs and you have a model for good health that will hopefully sustain you until the right drug options are available.

With regards to slow development of new drugs. I certainly agree that such agents can't come quick enough. However, it is worth noting that the pace of drug development for HIV is at a pace rarely seen in the past. In fact, new agents are coming quickly and like nothing we have ever seen in this field before. It is for this reason that many of us remain very optimistic about the future for people with drug resistant virus.

Best, Eric


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