CD4 Count: 39
Below 200—an AIDS diagnosis. Given the short time he’s been infected, such quick progression requires immediate treatment.
Viral Load: 280,000
High—might need meds even if he had more CD4s.
Viral Fitness (Replication Capacity): 165%
Resistanceusually makes HIV less fit. A replication capacity (RC) 65% greaterthan nonresistant, wild-type HIV bucks the trend.
Resistance Profile—22 mutations:
Nukes: Broad resistance, but some sensitivity to a few.
Themutations cause much nuke resistance, but it’s not all or nothing. Docschose Viread and Videx, to which he had some sensitivity.
Non-Nukes: No K103N mutation; resistant to Viramune and Rescriptor; partially sensitive to Sustiva.
The lack of K103N, which causes cross-resistance to the entire class, is a break. The docs chose Sustiva.
Protease Inhibitors (PIs): Resistance to all.
The many PI mutations suggest that the entire powerful class is lost to him, because PI cross-resistance is so common. But asCal Cohen, MD, of the Community Research Initiative of New England,says, both tipranavir and TMC 114, experimental PIs with uniqueresistance profiles, may serve should this combo tank.
Entry Inhibitors (EIs): No resistance.
The sole approved EI, Fuzeon, isn’t widely used, so it’s no surprisethat he has no resistance. The docs fingered Fuzeon as the combocornerstone. It seems potent against resistant HIV when teamed withanother active drug—in this case, Sustiva.
Prognosis: Aftertwo months, the nukes-plus-Sustiva-and-Fuzeon combo was showingconsiderable, if incomplete, control of the virus. While the manremains seriously ill, he has grounds for hope. POZ wishes him success and hopes he has found the support and empowerment available in the AIDS community—far from the doom-and-gloom headlines and hype.
How to Treat "Untreatable" HIV