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Third-Line Therapy

September 2004

A good working relationship with an HIV-experienced doctor is ideal for anyone living with HIV. This is even more vital when a person has taken many anti-HIV drugs. If you have taken many anti-HIV drugs, and your viral load is rising and/or your CD4 count is falling, then considering changes in your regimen is likely wise. The following is a roadmap of questions to consider when exploring changes in therapy.

Third-Line TherapyIs the virus resistant to any of the drugs you're taking?

Resistance testing is a good place to start. Resistance tests can tell you what anti-HIV drugs may be more and less potent for you. There are several types of resistance testing and each has its strengths. Work with your doctor to determine which test is best for you, and to understand the results. For more information on resistance testing, click here.

Third-Line TherapyCan you put together a regimen with at least two potent/active drugs?

Once you have answered these questions, look at the list of drugs you've created. How many drugs are on the list? Can you build a regimen with at least two active drugs? If so, construct the best possible regimen; one which has the best chance of working and that you are most likely to tolerate. Can you put together an alternative regimen if the first doesn't work? Having a strategy can help you make the best possible decisions.

Third-Line TherapyWhat if you can't construct a regimen with two or more active drugs?

Look into studies for new anti-HIV drug options. Will adding a new, experimental drug allow you to build a regimen with two active drugs? If not, the difficult question is whether it is best to wait until new drugs become available or risk trying a regimen with only one active drug.

Third-Line TherapyAre you prepared for the demands of the new regimen -- to adhere and monitor for side effects?

Whatever regimen you come up with, it is crucial that you take the medications regularly, as prescribed. The better you can stick to a regimen, including obeying food restriction and drug interactions, the better your chance of keeping the virus in check. For this reason, it is important to be clear and honest with yourself. Many people are better able to stick to a simpler regimen. A simpler regimen can mean fewer pills, fewer doses per day and fewer food restrictions and drug interactions. When building a regimen it is a good idea to keep these factors in mind.

Third-Line TherapyBased on a history of resistance test results, which drugs appear most potent for you?

Make a list of potent drugs available to you according to the resistance test results. Consider what is known about each drug, especially side effects, drug interactions and dosing schedule. Do you have personal experience taking any of the available drugs? What possible side effects are you more willing to risk or live with? What kind of dosing schedule are you most likely to be able to stick to?


Conclusion

Third-Line TherapyWhile the challenges of these kinds of treatment decisions can seem daunting, there are reasons for hope. Some of the newer anti-HIV drugs have worked well in people who have taken many drugs before. Two good examples are the drugs tenofovir (Viread) and enfuvirtide (Fuzeon, T20). Both of these drugs were studied and worked well in people with extensive anti-HIV drug experience. Also, there are drugs in development that are designed to work in this setting. For example, the experimental protease inhibitor tipranavir, has shown some promise in overcoming resistance to other protease inhibitors.

People who have taken multiple drug combinations to treat HIV face specific challenges. While your option might be limited by drug resistance, working with an HIV experienced doctor can help you make the best choices for you.

For more information see Project Inform's publications, Anti-HIV Therapy Strategies, Third-Line Therapy Strategies and Making Decisions About Therapies.


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