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What to add or switch to?
Dec 16, 2006

I am currently on Reyataz, Norvir boost and Truvada. My viral load was undect. for a year, the last test it went up to 218 and my doctor wants to add AZT. I have the following resistances: M41L E44D D67N V118I M184V L210W T215Y

Is the AZT a good idea? Am I running out of options, I'm pretty worried.

Response from Dr. Wohl

Generally, I confirm a newly detectable viral load before I change anything. In many cases, an unexpected small rise in viral load is a blip and repeat testing shows that the viral load is back down to less than 50. Was it a small burst of viral replication or lab error? Who knows.

But in you case, I would be inclined to add the AZT no matter what, unless your viral load is increases even high (>1000). Your virus has a bunch of resistance mutations that reduce its susceptibility to a number of HIV drugs, including the Truvada you are taking. The FTC in Truvada is no longer able to stop your virus from replicating and there are AZT resistance mutations that will make the other half of Truvada, tenofovir, less effective too.

So, why add AZT if your virus is resistant to it? If your virus level turns out to be ivery low (under 1000) I would do it to try to put pressure on the virus to keep the AZT resistant virus as the majority strain of HIV in your system. AZT resistant virus likely does not work as well as non-resistant virus. Further, AZT resistant virus has a hard time also being fully resistant to tenofovir. Therefore, AZT may kwwp around weak virus and 'protect' your HIV from developing the major tenofvir resistance mutation. Likewise, keeping FTC on board, helpd maintain the mutation against this drug and such virus is also less active. All this may drive the viral load down if it is at a very low level.

But, if your viral load is repeated and is >1000, I would favor a complete change in your therapy to as many active HIV drugs as possible, rather than just add some AZT.


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