Answer provided by:

Marty Markowitz, M. D.
Clinical Director
Staff Investigator, Aaron Diamond AIDS Research Center
Associate Professor, Rockefeller University

Question: I am a 43-year old male who was recently diagnosed as HIV+, but I know (100% certainty) that I became infected about 9 years ago. I am still waiting for the results of my CD4 and viral load tests. The question I have is this: Does the fact that I have waited so long mean that it is unlikely the HIV drugs will do me any good?

Answer: Quite the contrary...there is no indication that you can wait "too long"...

Question: Is the fact that I was infected before either protease inhibitors or non-nucleosides came into use mean that my virus probably will not be resistant to those agents?

Answer: It is highly unlikely that you were infected with a PI or NNRTI resistant virus....

Question: Do you recommend doing resistance tests for someone in my situation-I know they are expensive and can take up to a month, and that there are 2 different types-which type is better or more reliable?

Answer: Routine resistance testing is not recommended for chronic infection. In general the genotype in an untreated patient is adequate however in more complex cases phenotypes may be preferable.

Question: I have been researching HIV drugs and I have been told that the cocktail Combivir + Sustiva is a commonly used, generally well-tolerated, and highly effective "first-line" regimen. Do you agree, and do you think this regimen would have effective "lasting potential"; i.e. 3-5 years before resistance kicks in, assuming I stick to my schedule?

Answer: To date Combivir/Sustiva is the regimen that is consistently "superior" or "equivalent" and is considered the initial treatment of choice ...

Question: Lastly, what is your impression of these new "entry inhibitor" drugs that will be coming out in the next couple of years? I know that Peptide T-20 will be the first to come out, but do you think it would be better to wait until more of them are available and use the different ones together rather than just T-20 by itself?

Answer: Entry inhibitors are indeed a breakthrough, however, considering the current choices of medications and the ability to construct simple regimens...the use of these agents will be limited to those with limited options. This may change over time as drug development efforts mature.

I know this is a lot of questions but I would greatly appreciate a response whenever you have time.
Thanks.

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