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question about resistance to choose meds
Sep 12, 2004

Dear doctor, before anything, thank you very much for your time, and all the kind work you do. We need many people as you in this world. Well my question is: Is resistance due to the virus being exposed to meds before being contracted or it may be for any personal body or organic response?? For example someone infected in 95 before HAART, could be resitent, or only to those meds available at that time, vgr. AZT ??? My question is because here in south america the feno and geno test is so very exopensive and not evenavailable in most places. Considering that what would be a good regimen to start considering those 9 almost 10 years of infection????? Please answer as soon as you can to make a decision on the treatment to follow. Thank you in advance Derek from Chile

Response from Dr. Young

Derek, thank you for your question and sorry for the delay in our reply.

When we speak to baseline drug resistance, what we mean is the situation where the patient acquired a drug-resistant strain of HIV from the time of initial infection. This is not a "personal body" or "organic response", but rather a matter of having the wrong sexual parter, per se.

If you were infected in South America prior to 1995, it is highly unlikely that you acquired a drug resistant strain of HIV, since HIV medications were not widely available at that time (especially in South America). Even if you were unfortunate enough to be exposed to someone with drug resistant virus, since we only had nucleoside RT inhibitors in 1995, there's no reason to think that you have non-nuke or protease inhibitor resistance.

So, what to start? Given the previous discussion, I think that you could readily start on any of the recommended treatment regimens-- 2 nukes with either a non-nuke (we typically use efavirenz in this setting) or a ritonavir-boosted protease inhibitor (lopinavir/ritonavir --Kaletra; or boosted fosamprenavir or atazanavir). The newest PIs are attractive because of improved tolerability and resistance profiles, the pill counts now are similar enough to the NNRTIs that many patients once reluctant to use high pill count PIs are willing to try PIs.

Hope this helps. Buenos suerte. BY



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