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Ask the Experts about Drug Resistance and Staying Undetectable
My doctor made me change from Saquinavir/3TC/d4T to Sustiva/ddI/ddC on August 9th. I have never taken a NNRTI before, and genotype analysis shows resistant to ddI and ddC. My VL=7,000 and CD4=320. How long before I become resistant to Sustiva? Can I go back to my previous combo and spare Sustiva? The only two new drugs (besides NNRTIs) that I've never taken and could take are Amprenavir and Abacavir. Any idea? Thanks!
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Response from Dr. Little
It is always a bit difficult to evaluate your doctors treatment plans without all of the necessary data - but it appears from the information that you have given me, that you may be on sustiva only at this time (if you are indeed resistant to ddI and ddC, then their contribution to your current regimen may be minimal). The bad news is that resistance to sustive can develop very rapidly (as quickly as 2-4 weeks in some people). The chances of your developing sustiva drug resistance is probably most closely related to the duration of time you are taking this drug and not having complete viral suppression (ie. viral load less than 50). It would be a significant shame to lose sustiva from the list of active drugs which you could take to control your virus. The best way to prevent this, is to take a regimen which WILL COMPLETELY INHIBIT your virus - that is taking drugs to which your test results do not show that you have pre-exisitng drug resistance mutations. There are certain circumstances, when providers may choose to use drugs which they suspect may have only intermediate activity (ie perhaps "saving" a more potent drug class for later in someone's course if current T cells are high), but in general, it is best to try and use sustiva only with drugs that you think are VERY LIKELY to be associated with complete viral suppression. I would urge you to talk to your doctor about the reasons for choosing this regimen and perhaps what other options might be considered. This may still be a reasonable choice, but I always think it is a good idea if you understand the risks and benefits of each regimen chosen. Good luck.
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