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resistant to PI's and RT
Nov 13, 2000

Hi

I recently got a genotype and I'm currently on d4T, ddI, and Abacavir. I have previously taken PI's and was switched to current meds. The report came back with following mutations:

L10I, G48V, I54A, L63P, V82A, L90M

which suggest that I'm likely resistant to:

Amprenavir, Indinavir, Nelfinavir, Ritonavir, and Saquinavir

and RT mutation of:

M41L, D67N, K70R, L74I, V75A, A98G, K101E, Y181C, M184V, G190A, L210W, T215Y, K219E

which suggest that I'm likely resistant to:

3TC, ABC, AZT, D4T, DDC, DDI, DLV, EFV, and NVP

I have heard of Kaletra -- but will this new PI help me and if so what else do I take with it?

Thank you

Desperate and Hopeful

Response from Dr. Pavia

I have to be honest with you, that is a bad virus from the point of view of resistance. However, there may be some good news in that. Many people with highly resistant virus have virus that does not replicate well and does not knock down the T cell count as well as normal virus. In that case, your CD4 T cell count may stay up or even climb despite detectable virus load. This is sometimes called a CD4 disconnect.

Kaletra (lopinavir/ritonavir) may be active against your virus by virtue of maintaining very high blood levels. However,with 5 significant mutations in protease, it may not be fully active. More importantly, if you use Kaletra without other active drugs, it will be a waste of the drug. Therefore, if your CD4 count is stable, your best bet could be to wait. Tenofovir is available through expanded access at some sites, it is likely to be active. Capavirine is a second generation non nuke that might work - a trial is soon starting that will use it along with Kaletra. T20 is an injectable entry inhibitor that is in clinical trials and would be another option.

Hard as it may be to consider, you really need to decide if you need to do anything at this point, or if you can afford to wait. If your CD4s stay up, you are likely to stay healthy.

ATP

Andrew T. Pavia, M.D.



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