Question
How many combinations are there before salvage therapy?
22 December 2008. Related: All topics, Changing treatment, Resistance.
After 1st, 2nd, & 3rd line treatment, is it the end of the road?
Firstly let me thank you for your website and the hard work and effort that goes into it.
I am very confused about how many treatment options we have as patients. I understand that there are around 21 individual drugs, but how many combinations are there? I have read that we only have 1st, 2nd, and 3rd line therapy, before we are classified as being on salvage therapy. So effectively, we only get 3 chances, or 3 combinations, and then your hanging by a thread. So hypothetically speaking if you became resistant to your first 3 combinations fairly quickly, then its nearly the end of the road.
So how can the reports say we have a near to normal life expectancy, when we only get 3 or 4 combinations and then its pretty much game over?
Answer
You are right. If you get resistance to 3 or 4 combinations your options are very limited. You then have to wait for new drugs.
Although there are over 20 drugs, getting resistance to one drug in a class, usually results in resistance to other drugs in the same class.
However, you are only likely to get resistance if you miss doses of your meds. This is why near-perfect adherence is important.
Luckily, most people do well on their first combination and less than 5% people in the UK are resistance to all drugs from the nukes, NNRTI and PI classes. Getting undetectable on any combination can mean you can use that combination for years – in theory over 10 or 20 years – so long as you are adherent.
The i-Base guide to Changing Treatment goes into detail on all these subjects.
If you’d like a free print copy posted to you please use this link.
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