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Resistance and Drug Holiday
Apr 5, 2005

Hello Doctors,

My uncle has been positive for over 15 years. He has tried many drug regiments. In 1999, he developed resistance to sustiva. In 2004, he took a drug holiday for one year. His doctor did a recent genotype test on him. He has found that he is not resistant to sustiva any more and wants him to start his regiment with sustiva and some others(CD4<200 vl 35000). I thought that once you develop a resistance to a drug, that would be it. Why is his doctor starting him on sustiva again???

thanks Kar

Response from Dr. Pierone

You are correct once resistance to an agent develops it becomes archived (in macrophages, tissue reservoirs) and will emerge if that same agent is re-introduced. So this strategy is likely doomed unless the other medications in the new regimen are potent enough to carry the load without Sustiva. This is one of the reasons that when someone with HIV changes doctors or moves to a new locale the medical records, particularly genotype and phenotype tests, need to be brought forward in order to best determine therapy.



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