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Failing Therapy
May 5, 2008

I am hiv+ since 1993 and I am in failinig therapy since March 2001 (present therapy:Viramune+Abacavir+3TC; in the past I used AZT - D4T - ddI - Indinavir) but my CD4 (500 - 17% last control - 498 - 19.8% average in the last 2 years) and the viral load (25000 last result - 20859 average in the last 2 years) are stable.

My resistance profile was as follows in Nov. 2001: 41L - 74V -103N - 181C - 184V - 215Y - 33V.

My resistance porfile was as follows in Aug. 2007: 41L - 74V - 101R - 115F - 179I -181C - 184V - 215D - 33V - 64V.

In the 2008 profile mutation 103N "disappeared" and the 215Y changed into 215D.

My doctor says I might need to change therapy in 2009. When do you think it would be the best moment to change? When CD4 drop below 300? And what would it be the best option? Would I still be able to use Intelence/Etravirine? I am a bit anxious about changing a therapy that did not give me real problems in the last 7 years, I had so many in the past with d4T and ddI!. Thank you in advance for your reply.

Pierangelo

Response from Dr. McGowan

Pierangelo,

Fortunately in 2008, there are a number of new treatment options available that would give you and your doctor an opportunity to construct an HIV regimen that could achieve viral load suppression. If you are on treatment, viral suppression is the goal. Moreover, staying on a regimen that is not achieving viral suppression when more effective options are available because it is not giving you "real problems" is not a good idea since it may limit treatment options for the future. An example of what I am saying is staying on Viramune while your resistance test shows you have Viramune resistance (Y181C mutation). Staying on Viramune may risk your virus developing additional mutations against Viramune that may seriously compromise the effectiveness of Intelence/Etravirine.

Best,

Joe


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