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Resistance Test after a long Drug Holiday?
Oct 13, 2002

Dear Dr.

My friend has been on a holiday from meds since he started to show signs of resistance to D4T and DDI, about a year ago. We live in Thailand and both started meds around 4 years ago. At that time my friend's Doctor recommended that he use D4T and DDI (because it was a cheap option). He started to show signs of resistance, as the doctor had reduced the dose due to neuropathy. As his baseline CD4 count was high and his viral load was low he decided to take a long break from drugs. Now his CD4's are down at under 350 and viral load is about 28,000. It will soon be time for him to start meds again. Given that it is likely that he has some resistance to D4T and DDI and the long period since he has been on meds, would a resistance test be of any benefit? My friend is concerned that it is likely that he has already developed some resistance and does not want to throw away other options by starting off with an ineffective regimen.

Thank you for providing this wonderful public service.

S P

Response from Dr. Little

Your friend is correct in his concern that a drug resistance test after a one year drug holiday may not show any resistance to d4T or ddI, though resistance may be present, but at such low levels that it will not be routinely detected. I would not likely start out with a regimen that utilized either of these drugs, but this does not mean that I am "throwing away" these options. I think there are so many choices today that it would not be necessary to include these two drugs which may be marginal in their efficacy because of pre-existing drug resistance. In terms of how you would know - you don't really if a resistance test was never done, but if your friend had virologic failure (ie. had a detectable viral load while taking these meds in the past), then I would assume that he has resistance and try not to use them again unless absolutely necessary.


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