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Multi Drug Resistance
Jun 11, 2003

If you are resistant to two entire classes of drugs: NRTIs and PIs what are the options for someone with this kind of HIV drug resistant strain?

I've heard Viread is good for people for multi-drug resistance..but what would you use with it to give it a triple drug potency?

Response from Dr. Young

The treatment for persons with multi-class resistance is one of the central challenges for HIV treaters and for drug developement.

It's clear that using new classes of medications, like NNRTIs (or fusion inhibitors) would be useful for patients with NRTI and PI resistance. The key, and important part of your question relates to finding other medications to pair with the "new" class. My approach is to try to define which medications are likely to retain full (or as close to full) activity. The way that we typically use to determine this is resistance testing- and more and more, combined genotypic and phenotypic testing.

The pattern of NRTI and PI resistance is often quite difficult to predict after initial treatment failures-- some medications will typically retain activity; you've mentioned tenofovir- a drug which usually (but not always) has good activity after initial NRTI failure. Other options really depend on the resistance pattern. As for the proteases, using boosted PIs (like Kaletra, or boosted indinavir, or boosted saquinavir) often have sufficient activity to depend on after initial failure (especially unboosted)of PIs.

We really look to the future, too for newer classes of medications to provide options for those who have multi-drug; multi-class resistance. Drug classes to watch for include HIV integrase or entry (co-receptor) inhibitors. BY



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