Towards the path of least resistance

I’ve been positive since 1983, and like many other long-term survivors, I took each new drug as soon as it became available. Even after combo therapy arrived, I often mixed one new med that worked with others that were already failing. The practice proved to be a recipe for resistance. In the past two years, my T cells have dropped from 580 to 200, and I’m in “salvage therapy,” meaning that I take a combo of drugs to which I have resistance, hoping that together they’ll provide some antiviral action.But soon, I’ll have a new approach to consider. Eight new meds are either currently FDA-approved or will, within the next year or so, be approved or be available in expanded access, a program to get preapproval drugs to those in dire need. There are three fusion, attachment or entry inhibitors; three protease inhibitors (PIs); a non-nuke; and an integrase inhibitor. In the past, each new med was tested in combination with older ones. Now, some trials will test a combination that includes several new meds. In addition, long-termers like me can combine several new drugs that are in expanded access. I plan to wait for the expanded-access availability of a new integrase inhibitor, MK-0518, and team it with a new PI, TMC-114 (darunavir), which should be approved later this year. It seems like a blueprint for a working combo—and boy, will I work it.