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How did I develop a resistance .
Apr 16, 2009

Dr's, Great site and very helpful. Your answers have kept me from jumping off the ledge many times. I have been positive for 2.5 years and recently started taking meds for the first time. I have been taking ATRIPLA for a little more the a month now. My Dr. just informed me that I am resistant to Sustiva, despite when I was intially diagnosed being told I was not resistant to any drug. How could I develop a resistance to Sustiva?

Response from Dr. Young

Hello and thanks for your post.

I'm happy to hear that our forum has been of benefit to you, but am sad to hear that you appear to have developed resistance.

If you've not had issues (really) with adherence to Atripla, and had a baseline resistance test that did not reveal resistance to any of the medications in Atripla (tenofovir, FTC, efavirenz) then it is unusual that you have resistance now.

The most likely explanation is that you had a low level of resistant virus at baseline-- too low to be detected by the resistance test, but enough to quickly overtake the drug-sensitive, wild type virus in a short while (1 month). Indeed, I'd think that it would be quite unusual to develop new resistance in this period of time.

What to do now? I'd first have the test confirmed- this is too important a finding to base the treatment failure diagnosis on one reading. If confirmed, then know that second-line treatment options today are very highly effective and very well tolerated. I'd be looking at using a regimen that included a ritonavir-boosted protease inhibitor, but (of course) to include at least one or two other active medications.

Best of health to you. Stay in touch and never hesitate to write back.


Exposure to likely positive individule - pep started
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