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What to do - Aptivus?
Oct 5, 2005

Doctor, vircotype phenotpype showed mutations at 41L, 43Q, 118I, 210W, 211K and 215S and said I had susecptibility to all NRTI's, "maximal" to retrovir. No nNRTI mutations. PI mutations at 10I, 13V,, 33F, 46I, 48V, 54T, 71V, 74S, and 82A. What concerns me is the "rules-based interpretation" that I am "resistant" to Aptivus. In response to an earlier virtual phentotype my doc thought I'd be OK with Aptivus. A subsequent PhenoSense GT showed me "Sensitive" to all NRTI's and I have the "fold change" for each drug if that helps. Mutations at M41L, V118I, L210W, T215S. No nNRTI mutations and sensitive to all these drugs with "fold change" for Sustiva of 1.09. PI mutations noted to be L10I, L33F, M46M/I, G48I/V, I54T, L63T, A71V, T74S, and ?82A. No susectibility to PI's. Silent on Aptivus. Based on these results, wouldn't I be good to go with 3TC, Viread and Sustiva? Am I good for Aptivus? What would you R/x? Thanks for your help.

Response from Dr. Pierone

Hello and thanks for posting. The best answer to your question will depend on some additional information: viral load, CD4 count, previous treatment history, prior resistance tests, and any known antiretroviral medications intolerances.

The short answer is that this genotype shows mutations that indicate an intermediate chance of success with Aptivus (Tipranavir). The overall chance of success depends on some of the above-mentioned factors. If you have never been on NNRTIs and you don't have archived NRTI resistance, then you may do fine with an NNRTI-based regimen and may be able to save Aptivus. But again, treatment history, and prior tests will better inform this decision. Here is a link to a review of Aptivus resistance studies is you want to delve deeper into this subject. Best of luck to you!



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