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HIV Drug ResistanceHIV Drug Resistance
           
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treatment options
Sep 6, 2002

HIV positive pt.x8 yrs. Multi drug exposure.V.L.900, cd4 211.Resisitance testing shows AZT, NNRTI and resist and/or poss resist to all PI.T215Y,A62V,K103N,P225H,A98S, 184V,L90M,L101.K20R,M36I,F53L,A71V,G73S. Where to go from here?? Thanks.

Response from Dr. Little

A single resitance test result will tell you what type of virus you have in your blood stream now, but will not unfortunately tell you what was there 1, 2 or 3 years ago. This is relevant in your case, since based upon the genotype you list, your protease resistance is not that bad - and I would think you had multiple options, when in fact, you may have failed these other PIs in the past and have simply "lost" these detectable drug resistance mutation since then. In reality, a "lost" drug resistance mutation is incorrect. Once you have a resistance mutation, you have it forever - but as a relative proportion the resistant virus population may be at such a low level that our standard drug resistance tests will not detect its presence. This is why it is possible to have very significant drug resistance and yet a test result that does not show much of concern. It is critical to review all of your past treatment regimens (what you failed and what you had toxicity to) in conjunction with all past and present resistance test results. Only then would it be possible to devise a reasonable next regimen. Having said that, Kaletra is the PI that works best in patients with PI-resistant virus and it does not look like the NNRTIs are worth considering in your next regimen. So, perhaps a Kaletra plus 3 NRTI regimen??? I'm sorry, it's just impossible to guess without more information.


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