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Changing Drugs Before Resistance
Dec 21, 2001

Hi, I've been on HAART for two months now and have had great results and (knock on wood) no side effects from my Sustiva/Epivir/Videx combo. My doctor has told me that he switches people's combos before the virus becomes resistant, so that he can use those treatments again later on. I trust him very much, as he's been treating people with HIV for almost twenty years with good success. I'm just wondering what your opinion is regarding this strategy. It seems to make a lot of sense for long-term treatment, but I'm also getting scared of the day when he takes me off this combo that I'm tolerating so well and puts me on something that I may feel so great on. I'd appreciate any insights you may have. Thank you!

Response from Dr. Pavia

The short answer is that it is an interesting but unproven approach. I am interested in seeing research to try it but I do not use that approach in my practice. It is hard enough to find a regimen that one tolerates and is effective.

There has been discussion about this strategy for years, so called prospective switching. There are some theoretical reasons to think it might work, based on complex mathematical models. Up until recently, however, of the few trials that tried this, none showed a benefit. It would be fair to say though, that it had not been adequately tested.

An interesting trial was recently updated, called SWATCH. In this trial, 3 groups were compared -either ddI, d4T and sustiva, compared to azt/3tc(combivir) with nelfinavir vs cycling these regimen back and forth every 3 months. The group that switched appeared to do better at 1 year. This was a small trial, and needs to be repeated with more people before we believe it, but it may be that this approach works.

Soooo, I don't know that it is a bad idea, but I am a bit skeptical. Hope this helps

ATP



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