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Re: What to do . . .

Jul 3, 2005

Doctor, I wrote earlier . . . do the results of nNRTI resistance in African women given one dose of the other nNRTI give you pause or do you think I'm OK? I continued 3TC and Tenofovir for 5 days after 2 doses of Sustiva. Sure hope I don't lose that class of drug. With next genotype, if there is Sustiva resistance would it show? If not, how reliable would the test be? Thanks again.

Response from Dr. Young

Thanks for your follow up.

Yes, the results of single dose nevirapine (a NNRTI) monotherapy in pregnant women in Africa showed a disturbing amount of drug resistance. Presumably (and in accordance with our clinical experience here in the US), the rates of resistance following discontinuation of three drug regimens is much, much lower.

The strategy about continuing 3TC makes sense, but the half life of tenofovir is also quite long (though not as long as efavirenz (Sustiva)... therein lies the difficulty in treatment discontinuation-- not all of the drugs leave the body at the same rates.

A next genotype probably won't demonstrate drug resistance, unless you're taking medications. So, what to do? I'd be sure to have your viral load decline monitored very closely when you resume treatment. If the viral load does not decline at least 90% (probably better to see 95%) in the first 4 weeks of treatment, then I'd be looking to do a resistance test (I like obtaining both genotype and phenotype, but I'm in the minority on this).

Good luck, keep us posted. BY

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