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Sequencing
May 21, 2005

Dear Doctor,

My labs are the following: CD4 178; VL >100,000. My doctor began my regimen with Dapsone, I could not tolerate Bactrim. The antiretrovirals are Sustiva+Epzicom. What are your thoughts on this regimen? How soon should I expect failure/resistance on this regimen? If this is the case, what other future options could I probably have in the future? I will appreciate any respond. Thanks for all the work you do in this great website.

Response from Dr. Young

Thanks for your post.

Assuming that you continue to take your medications faithfully and you didn't acquire drug resistant virus, the combination of Epzicom and Sustiva should work very well.

In the CNA30021 and CNA30024 clinical studies, about 70% of patients never had a viral load greater than 50 copies after one year of treatment. Among the ~10% with viral failures, drug resistance mutations were only seen in about half (or ~5% of patients). Many of these patients had baseline drug resistance, emphasizing the importance of getting drug resistance testing before starting on treatment.

The kind of resistance seen among these patients is the key part of the preservation of future treatment option question. Most of these patients developed resistance to efavirenz (Sustiva) and 3TC (half of Epzicom). Additional resistance to abacavir was very rarely seen. Hence, patients who had the emergence of drug resistance were likely to compromise the use of future NNRTIs and some NRTIs, but should have quite a few future options, including the thymidine nukes, tenofovir and all protease inhibitors.

I hope this helps to clarify your question. Feel free to write back with any additional concerns.

Good luck, keep up the adherence. BY



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