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reuse of epivir
Aug 17, 2007

Doc,

Can I reuse epivir with a new combo with the m184 mutation. I would like to try Selzentry,3tc, tenofovir. Im getting mixed opinions on this matter. Im also resistant to NNRTI's now. What are your thoughts? Thanks in FL

Response from Dr. Young

Thanks for your post from FL,

3TC (Epivir) or FTC (Emtriva) are frequently "recycled" for patients who have HIV that has the 3TC resistance mutation called M184V or M184I. This is for several reasons- first is that 3TC retains some residual antiviral activity despite the resistance mutation. Secondly (and probably more importantly), virus that has M184 mutations that is treated with 3TC seems to be more sensitive to AZT or tenofovir (Viread). Since AZT+3TC is coformulated (ie., Combivir) and tenofovir+FTC is coformulated (Truvada), keeping 3TC (or FTC) in the mix doesn't add anything in the way of pill count (and rarely any sigificant side effects).

The real issue in your case is whether there are any additional mutations that might impair the activity of tenofovir.

Also, before using maraviroc (Selzentry), you'll have to have HIV tropism tested-- the test is called Trofile and available only from Monogram Bioscience. Some patient's virus is not susceptible to maraviroc. Knowing this is critical before starting on a maraviroc-containing regimen.

Hope this helps. BY



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