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Primary drug resistant to azt? Oh no!
Aug 27, 2002

Hi Doctor Young, I want to thank you for caring so much and always taking the time out to answer questions that are answered on this forum. I am in the camp of recently infected and am drug resistant to azt. This worries me because i know that now my options are limited. What are my best options now when starting? And should i expect now a shorter life expectancy than others? Thanks, I really value you taking the time out to answer.

Thanks,

Mia

Response from Dr. Young

Dear Mia- thanks for your comments and question.

I am happy to hear that you did have resistance testing done while recently infected. Your situation points out the possible value of testing during this period.

The answer to the effect of thymidine analogue mutations on your treatment options and prognosis would depend a lot on which mutations you have-- many TAMs would imply a certain degree of cross resistance; fewer means (generally) less resistance. We do know that having AZT resistance implies d4T resistance, so these two drugs are probably not great first choices. Other nukes, like ddI, abacavir and tenofovir have varying degrees of limited cross resistance.

There is also plenty of information about alternative regimens, like those that use two protease inhibitors (see Cohen, C from this year's Retrovirus Conference, for example)-- these data would suggest that you should have very potent first line choices.

I don't think that your life expectancy should be any shorter, but it does place a heavier burden on getting the first regimen right (right meds, right monitoring, right adherence). Also, if you've not elected to go onto therapy now, it might be an additional basis for waiting for more potent (from a resistance standpoint) drugs-- these might be important components of your second- or perhaps even first-line regimens.

Thanks again for writing. Let us know how you do. -BY



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