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New salvage regiment for treatment experienced
May 4, 2007

I am a 47 year old male who has been HIV+/AIDS for 12 years.I have failed/become resistant to about every drug. I am currently on Truvada, Norvir and Prezista. I have 30 t cells and a high VL. Fortunately the following drugs are available to me: Maraviroc(should I be CCR5+), MK518 and TMC 125. ANd still have some "sensitivity" to Fuzeon which I last took in a study 5 years ago. What new drug regiment would you suggest? Thanks!

Response from Dr. Daar

Thank you for your post.

As I am sure you know treatment is very complicated in general and particularly in those with multidrug resistant virus. Optimal management and decision making is made between a patient and an expert provider with access to the patients treatment history and past and present drug resistance test results. It is only with this information that one can define which drugs are likely to be active in a new regimen. The goal is to create a regimen that is tolerable and includes at least 2 fully active drugs.

In your case I would need additional information regarding your past treatment history and drug resistant results. Based upon this I could suggest which of the existing drugs, if any are likely to be active. From there we could determine whether you need to be on 1, 2 or possibly 3 of the drugs you list that are available through expanded access programs for those in need in the US.

If you are resistant to all available drugs then you likely would want to create a regimen with a few NRTIs, probably a ritonavir-boosted PI if there are any for which even partial susceptibility exists and MK518 (integrase inhibitor called raltegravir). If you are R5 only by the tropism assay adding the CCR5 antagaonist maraviroc would be logical and then possibly adding TMC 125 (a new NNRTI called etravirine). When embarking on such a complex regimen it is important to realize that experience is limited with each of these drugs and even more so when they are used together.

I can't emphasize enough that my comments are just general and not necessarily specific to your situation. The real answer needs to come out of a careful face-to-face discussion between you and an expert provider. That said, I would remain highly optimistic that you will do very well on your next regimen.

Best, Eric


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