Hello. I am in desperate need for your opinion. I tested HIV+ in 1990 when I had tonsilectomy and found KS in my tonsils. I have been on different therapies since 1996. I have become resistant to drugs in the three classes. My CD4 count has shown between 260 and 320 and viral load fluctuates, but never above 10,000 for several years. KS has been in remision for 11 years. Five months ago I got a new doc. and he suggested to go off med. and restart in a few months with a new regimen. As of my last blood results a month ago, My CD4 count was 258 and viral load in the 100,000s. I also noticed a small lision on my penis, which I think is KS; seeing dermatologist this week. I am about to start my new drug regimen, which includes: Fuzeon, Selzentry, Truvada and Darunavir with Norvir. However, I just found out how expensive Fuzeon is even with my co-insurance. I just can't afford it right now. I was wondering how efective the regimen will be without Fuzeon. Should I add another drug to replace fuzeon? Also, if I wanted to add Fuzeon down the raod, would it still be effective given the fact that I am now going to start taking Selzentry (an entry inhibitor)? My doc. insists that I have to take fuzeon now. It is either his way or the freway kind of thing with him. Thank you so much for your advice and hard work. G.V. Hello.

Thanks for your post.

Selecting a regimen for highly drug-resistant virus can be very tricky, though with newer resistance tests (I use a genotype and phenotype in these circumstances) and newer medications, like maraviroc (Selzentry) or the yet-to-be approved raltegravir (Isentress), the options are much better. It's key that your doctor has run the CCR5 tropism assay (called Trofile) to make sure that your virus is inhibited by the CCR5 inhibitor maraviroc.

Enfuvirtide (Fuzeon) can be a very important, indeed, life saving component to a HIV regimen, though, as you point out, the price is the highest of all HIV medications. If you have a percentage copayment, this can put the medication out of reach for some individuals. It might be worth inquiring about patient assistance programs from Roche before concluding about the financial impact.

In your case, if you have three drug class resistance and a detectable HIV viral load, you'd be eligible for the raltegravir early access program from Merck. At least untiil FDA approved, the medication is supplied without cost-- clearly less expensive than the bone-chilling costs of enfuvirtide (Fuzeon). Hopefully, Merck will not try to break any new price records when their very attractive integrase inhibitor is approved.

Best of luck, BY