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2nd Line Therapy
Feb 24, 2002

Dear Dr, what is the latest update on the 2nd Line Therapy? Have there been good news developing/progressing in this area. I guess my question relates very much on life span as understandably we need more options after failing the 1st combo/therapy. It does relate pretty much on life span, as many experts have predicted that most hiv+ will be able to live a normal life span, for that to happen, we will need to have a second line of defense if the fisrt one collapse. I hope you are able to answer this questions of mine as it will be of interest to many thousands out there (like myself) who hopes to live as long as we can and knowing that it is possible will definitely boost our confidence in handling our life. Thanks you so much for this wonderful forum. HT

Response from Dr. Young

Thanks for your question.

This year marks the 15th year of HIV therapies; we can happily say that we've come a long way since 1987. Not only do we have several combinations of therapy that can suppress virus among treatment naive persons, but we can talk meaningfuly about second-round and third-round therapies.

Indeed, I believe that, provided that one understands the basis for initial therapy failure (be it adherence, resistance or side effects) that the success rates for subsequent rounds of therapy can be very high. This is not to say that treaters should sacrifice the potency or durability based on planning for failure, but that with careful analysis, we can see successful so-called salvage therapy.

We certainly have seen the recent US FDA approval of ritonavir/lopinavir (Kaletra) and tenovofir (Viread); both drugs have important roles for treatment, and have activity in viruses that have drug resistance to many of our currently licensed agents. There are also newer drugs on the distant horizon; new second-generation protease inhibitors (Atazanavir, GW908, tipranavir) and second-generation NNRTIs-- to name a few.

Life span depends on many things, certainly for those with HIV infection, it definately depends on the ability to suppress the virus and maintain immunological health for a long time; having the ability to take simple, non-toxic HIV medications and having plans for subsequent rounds or therapy are important components to this long-term strategy.

Hope this is helpful. BY



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