Drug Resistant Hiv

[Sheryl]

A close friend of mine, Cambodian lady infected by her husband who in turn was infected in one of the brothels along the Poipet/Aranyaprathet border, has failed to respond to both first line and second line ARV. Her (no ex) husband likewise not responding so suspect the virus was picked up from someone already resistant to the common drugs.

I would be interested in hearing from others with this problem and what alternative drugs are available in Thailand and at what cost. She's had tests for resistance results of whihc are pending but we're very worried about cost.

the drugs she has failed to respond to are:

D4T

3TC

Neverapine

AZT

Thanks

[Digger]

Not sure if this is much use, but from the limited info I have, there are also the following available:

Stockrin - same category of drug as Nevarapine

DDI - Same category as D4T

Abacavir - Same category as D4T

Kaletra - Protease inhibitor - not same category as any of the above.

Abacavir is approx: 10,000 baht month and no idea about Kaletra, but it will likely be same or more expensive than Abacavir.

Resistance tests will be the key - if the doctors have followed int guidelines, they would be using 3 drugs which likely means that they have used initially:

d4T/Nevarapine + one other I can never remember (but not mentioned by you) - which together form the govts GPO-VIR subsidised treatment.

If that failed, then sounds like they have used AZT/3TC and Nevarapine in combination. Common drug would be Nevarapine which might be the problem. Swapping out Nevarapine and replacing it with Stockrin might be of some benefit but the problem of drug resistance may rule out all drugs in that class. Both Nevarapine and Stockrin are very highly rated drugs.

All of these drugs are very cheap (relatively) in Thailand assuming they are using the generic copies of AZT and 3TC - the originals are considerably more expensive as they are made by GSK and imported from Australia.

Once you have used up these options, things start to get very expensive - currently as I understand it, there is no effective 3rd option for subsidised/generic treatment so you are compelled to use expensive imported drugs such as Abacavir and Kaletra. If you go down this route, your likely looking at cost of 20,000 baht per month for medication.

One other drug is Viread (also called Tenofivir) which is not currently imported in Thailand. I cant understand why as its now considered first line treatment in the West but the manufacturers are trying to set up a study to give it to HIV negative people in Thailand to see if it works as a protection against the disease in high risk groups - seems a bit warped to me when there are thousands of people with HIV that actually could do with it as well.

Hope this helps

[maesaimanjit]

Not sure if this is much use, but from the limited info I have, there are also the following available:

Stockrin - same category of drug as Nevarapine

DDI - Same category as D4T

Abacavir - Same category as D4T

Kaletra - Protease inhibitor - not same category as any of the above.

Abacavir is approx: 10,000 baht month and no idea about Kaletra, but it will likely be same or more expensive than Abacavir.

Resistance tests will be the key - if the doctors have followed int guidelines, they would be using 3 drugs which likely means that they have used initially:

d4T/Nevarapine + one other I can never remember (but not mentioned by you) - which together form the govts GPO-VIR subsidised treatment.

If that failed, then sounds like they have used AZT/3TC and Nevarapine in combination. Common drug would be Nevarapine which might be the problem. Swapping out Nevarapine and replacing it with Stockrin might be of some benefit but the problem of drug resistance may rule out all drugs in that class. Both Nevarapine and Stockrin are very highly rated drugs.

All of these drugs are very cheap (relatively) in Thailand assuming they are using the generic copies of AZT and 3TC - the originals are considerably more expensive as they are made by GSK and imported from Australia.

Once you have used up these options, things start to get very expensive - currently as I understand it, there is no effective 3rd option for subsidised/generic treatment so you are compelled to use expensive imported drugs such as Abacavir and Kaletra. If you go down this route, your likely looking at cost of 20,000 baht per month for medication.

One other drug is Viread (also called Tenofivir) which is not currently imported in Thailand. I cant understand why as its now considered first line treatment in the West but the manufacturers are trying to set up a study to give it to HIV negative people in Thailand to see if it works as a protection against the disease in high risk groups - seems a bit warped to me when there are thousands of people with HIV that actually could do with it as well.

Hope this helps

HI is the hiv medicine in thailand heavily subsidized by the goverment.If so can u tell me where i could purchase them for my mom with a prescriptation of course.

[Sheryl]

Subsidized care would be only for Thai citizens who qualify

Thailand does produce in generic form some HIV drugs, whether or not these asre the ones you need, I can't say. AFAIK not sold over the counter, have to get from a doctor at a hospital so if the patient not here in Thailand could be problematic.

[SpudIslander]

Subsidized care would be only for Thai citizens who qualify

Thailand does produce in generic form some HIV drugs, whether or not these asre the ones you need, I can't say. AFAIK not sold over the counter, have to get from a doctor at a hospital so if the patient not here in Thailand could be problematic.

Hi Sheryl,

How can I find out more about subsidized care for Thai citizens who qualify?

[Sheryl]

It is the same as any other health care, nothing specific to HIV. People below a certain income level are entitled to low cost health care (the "30 baht scheme"although name may have changed) and others by virtue of employment are covered under a type of Social Security scheme. In bioth cases would have a card showing their entitlement. Patient just goes to a government hospital and present the card (make it at least a provinicial hospital, not a district one; one of the major hospitakls in Bangkok or CM even better).