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Treatment Naive with Resistance
Nov 23, 2013

Hi Doc, I'm trying to help a friend with low-English skills navigate being newly poz. He's very confused by the medical jargon, but doesn't want me to come to the doctor with him for cultural reasons (doctor is from his country and might perceive me being there as affirmation of my friends homosexuality). Thus, I'm trying to help him make sense of some of this second-hand.

He's treatment naive and has a viral load of about 12k and cd4 around 650. He suspects he's been poz for around 3-6 months. He also believes he contracted it in Central Asia, not the US.

His doctor told him that he cannot take Stribild because he is resistant to Edurant or ripilivine. Can you help us understand why that is? I thought that the main compound in Edurant was not in Stribild.

Also, how common is Edurant resistance in treatment naive people. I've not heard of it before. Particularly for someone who contracted in a part of the world where that drug is less common.

Thoughts?

Thanks, B

Response from Dr. Young

Hello B and thanks for posting.

If one assumes that your friend indeed has transmitted NNRTI resistance (to rilpivirine/Edurant), then I think that your question may be simply related to a misunderstanding. Rilpivirine is found not in the single tablet regimen of Stribild, but rather the single tablet regimen called Complera (or Eviplera in Europe).

Transmitted resistance to NNRTIs is quite common, but isolated resistance to rilpivirine is less so. To fully answer your question, it would be helpful to know the mutation pattern that the virus isolated from your friend has.

I hope this is helpful, and please feel free to write back. BY


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