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Is There Wisdom Here
May 5, 2008

My resistance sheet is pretty grim. I was having success taking Prezista, Truvada, and raltegravir, and Fuzeon. I couldn't take Fuzeon anymore. I'd been on it for 18 months and the site reactions became so painful and damaged me with huge bruise like areas on my stomach which have lost feeling. My doctors, yes I had two, one a study doctor for raltegravir and my ID doctor. I stopped the fuzeon without their consent. The thought of one more injection that brought me so much pain was too much for me. Monthly when i went to the appointments and they saw the site reactions I could see their dismay in their eyes though they decided that I should begin taking fuzeon again. I told them even though I wasn't apart of that decision I was not going to take it anymore. Now that you can see that part of this question, here is the rest. My viral load twice came back at 50 so my ID doctor took me off all HIV medications and it's been 5 weeks with three more to go before I see him again. He is considering putting me on Maraviroc, and TMC-125 and the medication "vacation" is for me to get enough viral load to run a test to see if Maraviroc will work for me. Every thing I know, after 21 years of being HIV+, says that this does not make sense, that I should never be off mediation. Is there any wisdom here with this tact that the doctor is taking?

Thanks for all you do for us,

Paolo

Response from Dr. McGowan

Paolo,

This is a tough question to answer without having all the resistance data in front of me. In general (and I mean in general), a treatment interruption strategy is not one that I would favor based on some recent studies like SMART. However, interrupting treatment may be necessary in certain circumstances such as toxicity to HIV medications. Going back to your question, one would need to know a) how active did your doctor feel that the Truvada, Prezista and Raltegravir backbone was as part of your regimen (were they all active drugs or only partly active)? b) how critical was Fuzeon to your treatment's success? c) how much prior NNRTI resistance does your virus have that would have compromised the effectiveness of Intelence (previously known as TMC-125)? The answer to (c) would help to determine if Intelence could have been substituted for the Fuzeon without requiring a treatment interruption, increasing your viral load and conducting a Trofile assay to assess the feasibility of Maraviroc.

I hope you do well back on your new regimen.

Best,

Joe


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