multiple ART resistance,what to treat?
Jan 6, 2000
54 year old patient with CD4 : 40 & VL > 700 000 has resistance to : SQV,IDV,RTV,NFV & AZT,DDI,D4T,DDC,ABV What would you treat him with? Is EFV + 3TC + Amprenavir an option? If, how would you adjust the Amprenavir dosing, since EFV decreases Amprenavir levels?
Response from Dr. Pavia
I am not sure that anything currently available will work. Are those resistance patterns from Virco, Virologics or is that from a genotype? I would be concerned that if there is abacavir resistance there may also be 3TC resistance but it hasn't been picked up.
Combining amprenavir and EFV is a problem since the decrease in AMP is about 40% and it is already a high pill burden. One way around it would be to use Ritonavir 200 mg bid, AMP 900 mg bid, and EFV 600 mg at hs. You are in unknown territory here though with the interactions. I would also want to include 3TC and I might consider ddI and HU since you will need more than 3 drugs for control. Sometimes these crazy combos work surprisingly well, and sometimes there are lots of toxicities, so be prepared, and monitor closely.
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