suggestions please

[penguin]

Anyone want to have a stab at this?

Current arv's : t-20, tmc 114(don't like its new name, sorry) , reyataz, fosamprenavir, norvir, tenofovir, 3TC.

Fosamprenavir  has decided to sputter out, as The Eels might say. We thought it’d last a bit longer than this, but clearly mr telzir has decided his work here is done.

Any thoughts?

Stop & switch to another PI? On paper, kaletra looks like it might still be a go-er. But I am reading the (paltry) amount of data available, and people are saying “no kaletra + tmc 114”…?

Switch to/add in another nuke? Not got much to choose from, really, 151m et al.. Small amount of susceptibility to azt still. *shudder*

Increase dose of fosamprenavir? Anyone point me in the direction of any research/evidence on this approach?

NNRTIs are out.

Obviously, main aim here is to keep t-20 and tmc 114 viable, as they are only fully,100%, active drugs in my combo. And at same time, keep me well(ish), with minimal side effects and  lowest possible pill burden.
I see dr Friday, have had brief conversations over the phone, but will discuss/decide properly then, just wanted some different viewpoints really>

VL - jumping around in an upwardly direction, about 15,000 at the mo (some of that will be due to recent shingles I ‘spect) Feel fine, as ever, maybe bit more tired n feet feel heavier of late. but otherwise, ok.

Thank you..

kate

[newt]

Kate hello,

A stab (in the dark perhaps, without a genotype or phenotype resistance test data)...

TMC114 increases the overall concentration of Kaletra by about 50% and Kaletra (well, the lopinavir in it) decreases the overall concentration of TMC114 by 35-40%.  This makes it a difficult combination to use.  But not impossible.  Provided each drug is within the limit for viral suppression (for TMC114) and darn nasty side effects (for Kaletra) it may be a viable switch for the Fos.  A little bit of Therapeutic Drug Monitoring c/o the University of Liverpool, or one of the London clinics that does it themselves, will tell you if this is working. It should be free, c/o the drug co's £s and/or NHS.

The Fos looks a dead duck in the water. 

Nuke-wise, you might talk about adding abacavir. Adding in AZT also may help but I sense a reluctance (understandable). Whether abacavir or AZT are any good, or just more drug pressure for more nuke resistance will be a moot point.   This really depends on your nuke mutations besides 151M and what your phenotypic resistance test says.  Abacavir will select for M184V, which is probably a good mutation in this context, since tenofovir is extra good at hammering this mutant strain.  You might try for commpassionate access to the new nuke TMC125, but I dunno if this is on the cards in the UK or whether it will even be useful.  Prob is available through an influential doc at a major London clinic.

If the major prob is nuke resistance you might be better off on a strong double boosted PI pair like TMC114 + Reyataz (perhaps at the 400mg dose) + 3TC alone for now.

You might actually be better of on a simplified regime of T-20, TMC114 + 3TC or summat like that for now. Depends on your PI resistance.

If you want a copy of the slide set with the TMC114 pharmokinetic & resistance data PM me and I'll email it's megabiteness to you.

For a really informed opinion you might also give Simon Collins (or A N Other) at i-Base a ring (but s/he will need your full treatment history and resistance test data). i-base website.

You need to decide your treatment target. Is it a viral load that's undetectable, a viral load of under 1,000 copies, or one under 10,000? This will make a difference to the drug selection and your mental anguish.  A lowish viral load made up of crap-replicating, heavily-treated virus may be a tenable position for a long time (ie until bright, shiny new resistance-busting drugs come around the block).

Good luck and a prayer, eh?

- matt

Now playing: Do You Really Want To Hurt Me, Culture Club

(this post required a half bottle of South African vineyard specific Sauvignon Blanc)

[penguin]

good lord, i have driven you to drink 

thank you, thank you mr newt, good suggestions...PM is winging its way to you...

Kate