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How many combos available?
Feb 25, 2002

Dear Dr, for a naive treatment patient (and assuming he has no resistant strain), exactly how many combinations will be available for him? And how long does one combo last if it is fully adhered to before the virus become resistant? Is it true that all combos will eventually meet with resistant? How many more classes of medicines will be available in the next 8-10years (based on your prediction)? I'm newly infected and would like to know exactly how much time I have. I'm only 33 and there is so much that I want to do but I need to know where I stand as of today. I'm also sick of all the contradicting statements which describe that HIV+ can potentially live a normal life span and some other describe that the medicines will eventually fail. I WANT TO LIVE AS LONG AS I CAN and I want to plan it carefully. Many Thanks

Response from Dr. Young

Let me see if I can clarify the discrepancy between these two positions.

Firstly, we now can rationally talk about long term survival in many (but not all patients). We have seen dramatic decreases in the death and complication rates; new and improved medications that make the daily hassle of treatments less. Indeed, we have clinical trials with very acceptable success even after 3rd or 4th rounds of therapy.

Nihilistically, the big concern is the eventual failure of treatments and the emergence of resistance (or worse yet, cross resistance). Long-term durability of medications requires a near unrealistic degree of treatment adherence (>95%); but provided that adherence is as dialed-in as possible and that there are no other side effect issues that limit the use of medications. We have seen many patients in our practice who remain sucessfully suppressed 5-6 years after starting on their first HAART regimen.

Given treatment failures, each subsequent round of therapy becomes more challenging, but we still have clinical trial data that supports a reasonable base for optimism. We are now looking at new drugs from old classes (second-generation NNRTIs, PIs), and really exciting possibilities for new targets (HIV integrase, fusion inhibitors, immunomodulating vaccines).

The best approach is to plan carefully, make well-informed decisions about treatment (when and what to start with, what to do next, how to monitor). I encourage my patients to develop productive and close communication ties with my or their other health care providers.

Hope this is helpful, good luck. BY



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