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simpler meds, but risk of resistance
Jun 8, 2006

I have been on diffferent types of therapy for around 8yrs but have many problems with side effects. This has become more complicated since having a heart attack two years ago, and being diagnosed with coronary heart disease. I find the pill burden I am currently on very difficult to manage but unable to take treatment break due to risk. My dr suggested maybe once a day dosing of combivir and nevirapine, but I am already resistant to 3tc (failed in 1998). Is there any evidence to show that if resistance developed it would either still be there or return quickly to 3tc? I currently take azt nevirapine and abacavir, have undetectable viral load and cd4 around 200 with % count of 11%.

Response from Dr. Wohl

Your current regimen is 3 pills twice a day. While not as simple as one pill a day, it is less pills than some boosted protease inhibitors. Things could be simplified a bit easily by putting you on Trizivir plus Nevirapine. You will still be on your AZT and abacavir but will only take 2 pills twice a day. The added 3TC probably won't hurt and may even help by reducing viral fitness (the ability of the virus to replicate).

Still too much, you say??! Then you might consider a switch to the about to be released Truvada+Sustiva pill. It is one pill before bed. To hedge bets you could continue on your AZT twice a day for 1 pill in the am and 2 at night. Not, bad.

The 3TC resistance is still there even if it is not detected in a genotype. Resistant virus persists but levels flucuate depending on teh stability of the mutant and the pressure to keep it hanging around (i.e. take 3TC alone and you would see lots of 3TC resistant virus pop up).

DW



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