Nov 6, 2002
DO mutations to nukes wipe out nonnukes or make them more suseptible to resistance?What are you supposed to do if you have a little detectable virus by not nearly enough to run a resistance test.If you have a little virus around 100 example. How long would it take for resistance to develop to each class of drugs and what should you do if you really don't want to intensify because you can't hack the side effects as it is? Cd4's are very good and never an issue,however risking drug options for future use is an issue due to being treatment experienced (but last pheno a few years ago didn't turn up any appreciable resistance)Thank you
Response from Dr. Young
Thanks for your question.
While mutations to NRTIs (nukes) can cause cross resistance to certain NRTIs, there does not seem to be any significant resistance to the NNRTIs (non-nukes). In fact, there is growing evidence that some NRTI mutations can actually cause hypersusceptibility (increased potency) of NNRTIs.
There is a limit as to the lower amount of virus required to get a resistance test. Currently the level is between 500 and 1000 copies. Unfortunately for persons with viral loads between 50 and 500, there is little that we can do to assay the viral resistance (yet).
Your question about the time to resistance is a very interesting one; but one without a clear answer. It looks like the answer also depends on which drug that your using. For example resistance to 3TC and efavirenz appear to emerge very quickly with non-suppressive regimens. Other mutations appear to take longer to emerge.
I hope this helps clarify some of your questions. -BY
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