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follow up ?(VL - change meds? (Jun 26, 2003) _

Jun 30, 2003

<< Keep us informed and if you have the specifics on the genotype it would be helpful. Good luck! >> I wanted to write back and let you know what the LabCorp report said.... and was hoping you could interpret it for me. The ONLY mutation that showed up was "resistance possible" to Lamivudine... the associated mutation was 44d. My doc wants me to stay with the Epivir, Viread and Viramune for 30 days then be retested (I'm on day 12). I really have NO idea what this 44d is??? If my VL stays at 2000 or increases what options do I have with this possible mutation? Should I get another genotype done? Also... I got my genotyping done BEFORE I started ANY meds. Thank you---- you have no idea how much your time is appreciated!!

Response from Dr. Pierone

This is helpful information. The E44D mutation in combination with other RT mutations appears to increase the chance of resistance to Epivir. In your situation with the E44D alone there is probably not significant resistance to Epivir and the decision to continue the present regimen with an early retest is reasonable.

If your viral load does not resume its decline, or instead goes up, one reasonable approach would be to intensify this regimen. The decision to intensify may also be guided by another resistance test, this one on your current regimen. In some instances, early resistance mutations do occur and require intensification or a complete change in strategy. However, if your viral load resumes its decline on your next blood test, then just hang in there and see how things progress.

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