Re: Re:Adding 1 regimen
Aug 1, 2002
Dear Doctor, Here in our place there is some kind of unclear opinions amongst the concerned physicians, regarding switching of regimen. Well earlier I had asked you about adding a new regimen to a double therapy ( AZT & 3TC). Some of the doctors here says it is okay to add one regimen if the previous regimen are not resistant. Some says atleast two out of three regimen must be changed. Could you please give your comment on this ? PPS: The tests like V/oad, CD4 and resistance here in our place are beyond our reach. Therefore we usually go for the clinical signs. Regards.
Response from Dr. Boyle
If viral load is not available and you cannot document suppression to <50 copies/mL on the regimen the patient is on, then the best thing to do, in my opinion, is to change or add at least 2 drugs and the drugs that elected should preferrably have a different resistance profiles than the antiretrovirals the patient is currently taking. If you add just one drug to a regimen that is "failing" (i.e., not fully suppressive), especially a one point mutation drug (where high levels of resistance develop with only one mutational change), then you are likely to end up with rapid failure of the new drug, which is obviously not what you want.
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