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HIV Drug ResistanceHIV Drug Resistance
           
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Seeking active meds
Jul 9, 2004

I've got some resistance and need to pick a new regimen. RT: 67N 70R 184V 219Q 333E 103N 106I PI: 10I 30N 36I 71T 88D Drug history: AZT, d4T, AZT/3TC; at this point I added IDV, which reduced my VL from 300K to <400 over about a year; swapped NFV for IDV due to kidney stones and within a year VL was up to 30K; tried ddI/d4T/HU for a while, VL stayed under 10K; switched to EFV/ABC/adevofir/3TC/HU and was <40 within 4 months; almost immediately became detectable, but never more than a few hundred copies; went back to the ddI/d4T/HU to avoid accumulating resistance; quit that in 2002 due to incipient neuropathy. So... I think that since the IDV suppressed my virus, with little or no help from the AZT/3TC, with which I had prior experience, I probably don't have much PI resistance other than the 30N mutation that shows up on my tests. This would account for the NFV failure. In a similar way, the fact that I was suppressed or had low viral loads on EFV/ABC/adefovir/3TC/HU even though I have 103N indicates that I probably don't have much nuke resistance other than the 67N/70R/219Q TAM pattern. Otherwise, what's suppressing the virus if the EFV is knocked out by the 103N? This leads me to a combination that includes a PI, obviously, and maybe TDF. I'm thinking either LPV/r/TDF/AZT/3TC/T20 or LPV/r/SQV/T20. The AZT/3TC in the first possible regimen is there because my doctor believes it will prevent K65R and keep the TDF active. Any thoughts or suggestions you have would be greatly appreciated.

Response from Mr. Kurtyka

I think your proposed combinations look like pretty decent options. Let me throw a couple of other potential thoughts into the pot. Do you have any phenotypic data or has all your testing been genotypic? As much as I appreciate the genotypic data, I tend to believe that having both genotypic and phenotypic information tends to help make the best decisions regarding ARV regimen changes. Do you have access to any clinical studies? There are some second-generation non-nukes that might be of value to you in your next regimen. Of the two regimens you suggest, I like the first one best. When Gilead comes out with their combo TDF/FTC will make it a little easier (substitution FTC for 3TC). I think it's a good time to consider T20 it's best to use it when you still have some active drugs available rather then when there are none.

--dk


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