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Resistance problem
Feb 9, 2008

I have resistance for all (NRTIs except didanosine and Possible resistance for tenofovir also have reisistance for nevirapine but I don.t have problem with efavirenz and also no problem with all Protease Inhibitors , now I am taking (lopinavir \ ritonavir + lamivudine + didanosine ) two months ago but I am still so sick and the CD4 still decreasing so what should I take from the rest of non resistance drugs considering I don't have any specialist Doctors in my country

Response from Dr. Wohl

This is a very difficult situation and a tough question for me to answer as I do not know what country you are in and therefore what medications are available to you. Also, while it is clear that you are having side effects from the meds and that your CD4 cell count has declined you do not state whether your viral load is undetectable or not.

If you do have an undetectable viral load, you could switch from the ddI (which may be teh cause of your symptoms and the dropping CD4 count) to Tenofovir. If possible, you might want to try to take the tenofovir with AZT as the AZT may help prevent tenofovir resistance. I would keep on the lamivudine and the lopinavir/ritonavir. If you continue to be sick on this regimen it may be that the lopinavir/ritonavir is the trouble. If so, write back along with more info.

If your viral load now is not undetectable a complete change in your regimen might be needed. What to switch to would depend on what is available. Here in the US there are a number of options including new classes of HIV meds. But, these may not be accessible where you live.

DW



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