|sti and resistance
Apr 5, 2001
i have read alot recently about studies taking meds every other week . 1 wk on 1 wk off. I discussed this with my doc and he does not reccomend trying it. Can resistance occur if i were to concider trying it? current meds 3tc, d4t, ziagen. Vl <50 cd4 700. Vl at starting meds was 15000 aprx 5 yrs ago. lowest tcells were 279. also why does resistance occur if you miss a few doses and resistance doesnt occur if you stop for a period of a few months and go back on?
Response from Dr. Boyle
There is currently a trial underway at the NIH to evaluate this strategy called "Stuctured Intermittent Therapy". To this date, they have not reported the development of resistance, but this is still not something that should be done outside of a very carefully monitored setting. If things go seriously awry, you could end up with many NRTI mutations that could significantly compromise your chances for future treatment. So, like your doctor, I would not advise you to try this strategy yet. Regarding your second question, resitance generally does not develop when you are off antiretrovirals because there is no "drug pressure" to encourage resistant quasispecies to persist and replicate. Missing doses or whenever you are starting or stopping medications is a particularly dangerous time since as drug levels drop the virus may start to replicate and there may be just enough of one or more of the drugs around to supply the requisite "drug pressure" for resistance to develop and persist. This may be especially true regarding 3TC, which requires just one mutation (M184V) for high-grade resistance to develop. BB
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