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Salvage Regimen
Apr 4, 2013

I am having delays in getting doctors to respond, make appts., etc. to consult on new combination and cross resistance. The curse of not having medical insurance, I guess, but I do need good information until and especially when I do speak with medical providers. So: Planning to start ARV meds after 6-year doctor-recommended holiday with modest resistance. Prior meds were Viramune, Videx, Zerit for ten years. Genotype taken in 2006 showed D67N/K70R/K219Q (NRTI) mutations, V106A (NNRTI) mutation, and "other" RT mutation at R211K. My research indicates low-level NRTI resistance. PS: Recent genotype test came back as wild-type. Proposed regimen is Truvada, Norvir, Prezista. Basically, my question is: are there significant concerns about cross-resistance (esp, NRTI class) with this regimen, and are there any suggestions for what may be a better combination in light of history I have detailed above. Your reply is most appreciated.

Response from Dr. Young

Hello and thanks for posting.

I like using the free Stanford University HIV DB resistance testing algorithm. If you input your virus' resistance mutations into the program, you find that you have relatively limited resistance: low- or intermediate level resistance to the NRTIs abacavir, AZT, d4T, ddI and tenofovir and to the NNRTIs efavirenz and nevirapine (high level).

With this pattern, it's relatively easy to construct a second-line regimen (I wouldn't call your next regimen "salvage"). I'd have no concerns about the potency of a Truvada (tenofovir+FTC) and ritonavir-boosted Prezista regimen- indeed, this is actually also recommended as a first-line regimen in current US treatment guidelines- testimony to the regimens potency and tolerability.

Hope that helps, BY



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