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HIV Drug ResistanceHIV Drug Resistance
          
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Three classes resistance
Feb 23, 2002

I am on Sustiva Crixivan+Norvir (800+100 x 2die) + d4t, now after one year of negative viral load, my viral load is 12000 and cd4 800. I am going to test if I am resistant, but to have a result it needs 5 weeks. What do you think About this situation? Is better to stop meds waiting the results or not? I am resistant to all the NRTI So what could be the next step? Thank you very much for your job.

Response from Dr. Little

If I had to guess, I would predict that you have developed resistance to sustiva (efavirenz). In general, I will continue treatment in patients waiting on drug resistance tests if their CD4 cell counts are high (as is yours) and the test results will take less than 4 weeks. If the test will take longer, I am more inclined to stop treatment while waiting on the resistance test results. I would obviously also confirm the one elevated viral load to be absolutely certain that this is correct. If you have developed resistance to the NNRTI and already have resistance to the NRTI drugs, then I would be looking to Kaletra as my Protease inhibitor of choice - it has the best activity against virus with resistance mutations to the protease class of drugs and is fairly simple to take. You could also consider the use of tenofivir - which has activity against virus with the 184V mutation (from 3TC use) - Tenofivir plus 3TC plus Kaletra, plus perhaps another drug (to be determined from drug resistance tests) could be quite active for you. If your choices are extremely limited, you might want to look into use of T-20 through a research study which would allow you to use the best available regimen for you - plus the addition of T-20. These options should be discussed with your doctor, who should also be able to refer you to a site near you where clinical trials are available to see if you might benefit from participation in one with access to a new class of drugs (such as T-20). Good luck.


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