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trizivir and viread failing?
May 8, 2004

i was relocating from south cali. to north cali. in january of this year..i had a problem getting my meds here and ended up missing 4 days of the viread.. i was tested that week with my lab tests coming back as 730 cd4s and 500 in viral regime has been 1 and a half dec.2003 i was at 1200 cd4 and undetect.v.l.... i have been on only nnrt since i started meds about 8 years ogo.. i have a new dr. here and hes not sure about genetype or if i should have it checked. he wants me to wait another 3 months and test again..because i was under alot of stress during my move..i would like to know if this sounds like resistance and if so what can i do..i have not been resistant to any others i have been on...thank-you

Response from Dr. Sherer

The circumstances you describe are not necessarily an indication of resistance to your current regimen, though they could be an early sign. 'Blips' of viral load increases between 50 and 1,000 are common, occuring in 40% of participants in one clinical trial. In that trial they were not associated with resistance or a greater likelihood of eventual virologic failure. A repeat viral load is the way to make that determination.

While a drop from 1200 to 750 CD4 cells is high, there is more variability in CD4 cells when they are in the higher range. Was there also a drop of more than 3% in the CD4 percentage? If not, there may be less significance to this change.

I would agree with a repeat viral load and CD4 test, and a genotype in the event that the viral load is 1,000 or more. I would advise that these tests be done in a shorter time interval, e.g. within one month, to address this important question.

Four days without viread (also know as tenofovir, its generic name) could increase the chance of resistance to that drug, depending on how well trizivir was controlling the virus on its own. That in turn would depend in part on whether you were treated before this regimen with any of the drugs in trizivir, i.e. AZT, 3TC, and ABC, what the experience was on past regimens, and whether you were known to have resistance mutations to any of them, though you indicate that you were not.

The mutations to be concerned about include the K65r (tenofovir, 3TC, and ABC), the M184V (3TC), and thymidine mutations (AZT), and some others.

I urge you to take these issues up with your doctor again.

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