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NNRTI Resistance
Apr 24, 2008

Hi there.

Firstly - thanks in advance to you and your colleagues for the time you devote to answering questions. This is a valuable service and has been of enormous benefit in terms of information gathering.

I was diagnoised six months ago but still have a reasonably good immune system (CD4: 470, VL: 10,000, CD4% 35). Some concerns with short term memory but otherwise feel good so doctor has not recommended drug therapy yet. Just after diagnosis, the reistance tests revealed the K103N mutation which puts Efavirenz and others of the NNRTI first generation meds off the table as a regime. I guess I have two questions:

1. Can this mutation disappear ? 2. Is it worth me chasing my doctor to have the resistance test re-run just in case there was a mistake ?

I don't want to waste valuable resources but if there is a chance I can take Efavirenz/Atripla (given the once daily dosing schedule and reasonable side effect profile)then I would like to when the time comes.

Many thanks in advance. P.

Response from Dr. Young

P, thanks for your post.

It would appear that you're among the ~10% of American HIVers who are unfortunately infected with drug resistant virus. Yours is the most commonly transmitted pattern, namely to NNRTIs (first generation non-nukes), like efavirenz.

While the mutation might disappear from future testing, this does not mean that the resistant virus is gone from your body, rather that the amount of the resistant strain has decreased below the level of detection from the test.

Once detected, this becomes part of your medical (or virological) history. I don't think that repeating the test has any significant value, nor do I think that using efavirenz or nevirapine is worth the risk of treatment failure and/or additional drug resistance.

Fortunately, we have sufficient treatment options that constructing a potent and well tolerated, once-daily drug regimen for you should not be difficult when the "time comes".



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