Very complicated resistance profile ... Really need advice...

[nomatterhow]

Hi , I posted here a month ago , I have a very complicated resistance profile which worries me and the 2 doctors whom I saw ... I have a low cd4 of 140-180 and I need a treatment urgently but apparently there's almost nothing left!!! The laboratory I did the test in and the doctors both think thi is a very old virus I have in me and all asked me if I have been taking HIV medications before!!! I am 30 y.o and my last negative test was early 2010 ... The tropism test showed that my virus uses CXCR4 receptor which is usually e case in older infections ... I am even resistant to all integrase inhibitors , all PI's except Prezista , all NNRTI's except Intelence ... Among NRTI's I am resistant to AZT and Zerit



My first doctor wanted to put me on truvada Intelence and Isentress but the second one I saw did an integrase inhibitors resistance test and found out Isentress wouldn't have worked


What you guys think I am seeing my doctor again on 16th ... Apparently I will be given some huge cocktail of pills cuz this is somehow never-seen! I am just sad and worried , the whole shock since my Poz test is just a lot especially that I just started new life projects etc etc

[Miss Philicia]

First of all, your doctors are correct (without seeing your profile here) that this wide-spread resistance is exceedingly odd in a newly diagnosed patient, and indeed it will complicate your med choices going forward. It's definitely the type of thing that can be seen mostly in an HIV patient that's been on medication already for two decades, and built up resistance issues from pre-HAART suboptimal treatment use and/or exceptionally bad adherence.

Basically any doctor will have to treat you as if you'd been on treatment previously like I just described even if the reality is that you are newly diagnosed. You live in Paris so it should be feasible to locate the best doctor for such situation, and indeed it seems like your current doctor(s) are on top of the situation.

[buginme2]

All is not lost.

You still have plenty of NRTI's available to give you a standard base treatment.  You did not mention being resisant to Truvada so I assume that would be part of your initial regimen.

You could then pair Truvada with Pesista/Norvir or Intellence.  In the next year or so there is another Integrase Inhibitor in development that is effective against resistance to Isentress. 

You Will need to be completely adherent to whatever medication you start.  You dont want to develop any further resistance problems.

[Miss Philicia]

You could then pair Truvada with Pesista/Norvir or Intellence.  In the next year or so there is another Integrase Inhibitor in development that is effective against resistance to Isentress. 

If you read the OP's very first post when he joined you will see that his doctors want him on a "HAART + 1" type regimen, meaning four active drugs from three classes instead of the standard 3 from 2. Many people (like me) with complicated resistance profiles have to do this.

[newt]

How about being belt and braces and going for Truvada/Intelence/Prezista. This will cover all bases, offer the best chance of overcoming resistance and achieving full viral suppression. This will be a 2 x day combination (but it's gonna save your life right?) << I would do this

Once undetectable you may consider simplifying to by dropping either Intelence or Prezista. This will also be a 2 x day combination. << I would consider this

More conservatively, and depending what seems the best option according to your exact resistance profile, you can start on Truvada + either Intelence or Prezista. This will still be a 2 x day combination. << I wouldn't do this unless I had no choice

Despite your resistance to several drugs, I would still expect treatment to be successful and achieve an undetectable viral load.

Transmitted resistance is fairly common, although extensive multi drug resistance like yours is not.

Buginme is quite right to say there are several resistance-beating drugs in late stages of development, so hopefully your treatment options will widen in the next 2-5 years.

Hope this helps.

- matt

[nomatterhow]

Hi !!! Thanks For your messages ...

I am not resistant to Truvada , but possibly resistant to Intelence but my doc told me I would take truvada Intelence ... And either Prezista or Aptivus ( forgot to say I am not resistant to Aptivus ) plus Norvir.... Bt Aptivus is having serious side effects ...

I also did a test called HLA something to determine if I am having hypersensitivity issues with Abacavir in case I should take that .... I think I am in good hands but my doc told me the treatment I start it SHOULD work cuz I don't have much other choice if I develope resistances after !!!!


I just hate this!!!! As if being Poz is not stressful enough , now I see I have the rarest virus ever :-/