Do not do as I did

Please read the article written by Enid Vazquez in the latest Positively Aware, one of the main free HIV magazines distributed around the U.S.

My comments are in the last part in the section called “Don’t do as I did”

I want to make sure that people who are applying for TMC 125 expanded access are very careful when assuming that this medication will be represent an “active” agent. No genotype test for EAP drugs is available, so we are in danger of assuming that a new drug is an active drug (this assumption may not be true when starting drugs in existing classes). An active drug is one that is shown in your resistance test (genotype or phenotype) to have a good chance to work in controlling your virus. Another danger with TMC 125 is that it is a NNRTI and we know that prior NNRTI resistance can be archived and not show up in genotype tests. Many patients like myself with extensive NNRTI resistance in the past show activity to that class in our genotype test. If the doctor does not carefully review prior medication history and asks the right questions to the patient, both the doctor and patient will assume that there is no archived prior resistance. So be very careful!

If you are to start a new combo with MK 518 integrase inhibitor, a drug that is showing more promise than most for patients with multidrug resistance, make sure that you start it with Fuzeon (if you are Fuzeon naive) and/or Maraviroc (if you have a R5 tropic virus) unless you can be 100 % certain that TMC 125 will work on your virus. With all the hype surrounding TMC 114, I made the terrible assumption about the activity of TMC 114 (Darunavir, Prezista) when I got that drug via EAP to start it with MK 518 as part of Merck’s phase III study. Read more in the link below.

Around 30 % of people who have extensive Kaletra and protease resistance may have pre-existing resistance to Aptivus (Tipranavir) and/or Prezista (Darunavir). No one is talking about this and there are a few conference posters on the subject but not discussed by anyone. Do not fall prey of the hype that is built around new medications, unless they are in a new class that you have never taken before and that show great response. This is the best chance for many of us to attain undetectable virus and hopefully keep it that way for a long time, if you do it right the first time.

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