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Sustiva and Resistance
Sep 17, 1999

Hello, I wrote earlier and asked if my different conditions and medicines would mess with my numbers, I will try to clear it up some. For the last two years my t-cells have been at around 200 and the viral load has been undetectable. I had been on Norvir until the tablets were discontinued and I was switched to Viracept last fall. The viral loads started rising, so they put me on Sustiva last month, and I am on that now. I am due to get blood drawn this Wednesday(9/15). I have been taking these with Zerit(40mg, 1 twice a day) and Epivir(150mg, 1 twice a day) throughout, though they did lower the Epivir to 100mg, once a day instead of twice. My real question is, should they have put me on Sustiva even though they didn't change any of the other two? I read somewhere that it shouldn't be used unless they put you on something that you haven't been exposed to already. Wouldn't this increase the chance that a resistance could develop? You mentioned earlier that the Epivir might be suspect(why would they lower it, anyway?), I don't think it's the Sustiva, I have only been taking it a month. I am curious to see what the bloodwork says, to say the least!! Do you have any suggestions on questions I might ask on Wednesday? I just wonder if I am on the right regiment or not, any comments would be very much appreciated!!

Response from Dr. Holodniy

Sorry, I didn't get to this before 9/15. I was fighting to get out of the way of HUGO. You are correct that you should be changing more than one agent in a regimen. Depending on where your viral load was (ie not too high, < 5-10,000), you might be able to get away with just adding sustiva because of the potency of this agent and the almost certainty of getting to < 50. The likelihood of d4T resistance is almost zero. So you would still have that drug going for you. I don't get 100mg epivir thing. There is prelim data that you can give 300mg of epivir once a day (which is the subject of an ongoing study). I would consider the dose of epivir you are on suboptimal, unless you are using it to treat hepatitis B virus, which in you they are not I assume.

MH



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