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HIV Drug ResistanceHIV Drug Resistance
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not able to take my meds due to illness.
Jan 1, 2002

I have been taking medicines for two years (Sustiva, Ziagen, Epivir, and Zerit. For more then one year, I have a viral load of less then 400 (except for one blip of 577 4 months ago...but my last test was less then 400 again). I take my medicines at 11:00am (for the Zerit, Epivir, and Ziagen), and 11:00PM for the three above + Sustive. My tcell count has always been above 500 and my last count was at 1200. Last night starting at 8:00PM...I was throwing up and had a case of diarea. I have no idea what caused it. When I approached the 11:00PM deadline, I contacted my doctor who stated that I should come off the medicines for two days rather then attempt to take them and throw them up. When I brought up my concern about resistance to the meds, he replied not taking them for two days is the lesser of two evils and that it is better then attempting to take them and then throw them up. At about 2:00am, I think I would have been able to take them, but decided to stick to his advice and wait it out the two days. Would it have been better to take them at 2:00am since that was only 3 hours past my deadline? If not, should I have taken them at 11:00am this morning (the next day)? Am I doomed to a resistance in the short term since the levels of medicines in the body leave at different times (I have read that Sustiva can take two days to leave the system..thus having the Sustiva fight on its own might lead to resistance to it)? I really want to know your opinion. Thanks.

Response from Dr. Little

I do not think that stopping your medications for effectively one evening is going to put you at any great risk for resistance. It is true, that prolonged illness which does not allow you to keep your meds down is frequently associated with the suboptimal drug levels which we worry about - hence the recommendation to skip the doses while you were ill. In general, the sooner you restart the better - but this has to be balanced with the risk that you may actually start up too soon (2:00 am in your case) and then become more nauseated and not be able to hold down the meds after all. I do not think that you need to be greatly worried. If you are being followed with viral loads using a 400 copy threshold though - I would ask your doctor about the more sensitive assay which measures down to 50 copies. It may be possible to catch an impending failure much earlier using this assay - and provide a better estimate of truely undetectable.

resistance testing before starting drug therapy

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