[procaare] Re: Why all this hysteria about Fuzeon pricing in New York?

[Patricia Yeargin <procaare@healthnet.org>]

Re: Why all this hysteria about Fuzeon pricing in New York?
- Patricia Yeargin,Southeast AIDS Training and Education Center,Atlanta
***************************

Dear Colleague,

I know many people who are indeed adherent to their medications, but for a number of
reasons have not responded well to treatment.  I've lost colleagues to the old days of
mono- and dual therapy, for example--people who were infected in the early 1990's got that
as standard of care.  We had no protease inhibitors until 1996.  I'm not jumping on the
bandwagon with ACT UP, but there are many people who are out of antiretroviral options.

There are indeed more than 20 drugs on the ARV menu, but class-wide drug resistance is
common among NNRTIs(Non Nucleoside Reverse Transcriptase Inhibitors), and to a lesser
extent among the PIs(protease inhibitors); and one has to have virus susceptible to at
least 3 drugs to cobble together a regimen.  And, effectiveness tends to decline with each
successive regimen after one fails. Lots of reasons exist for drug resistance.

There are people who were not taught properly how to take their medications, or who
misunderstood the instructions. I've uncovered several of those personally, and they tend
to be discovered late. There is also the issue of drug interactions which lower blood
levels of specific antiretrovirals, increasing the likelihood of resistance. I don't know
about where Romy is, but that isn't always picked up by health care providers or
pharmacists in the US--indeed, clinicians may not even know all the drugs and supplements
the patient is taking.

Now, we are seeing people who got their primary infection with a resistant strain. I'm not
saying that there aren't people whose resistance is due to non-adherence, but it is far
more complex than that.

I'm happy that Romy Mathys has been so successful in his HIV treatment, and I wish him the
best. Keep in mind that many others have not had the same opportunities that Romy has, so
please don't judge them all at fault.

Patricia Yeargin, MN, MPH
Clinical Instructor
Southeast AIDS Training and Education Center
735 Gatewood Road, NE
Atlanta, GA  30322
Email:	pyeargi@emory.edu


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