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Time for a PI or not ?
Aug 24, 2004

Buongiorno, and thanks for the wonderful job ! I tested positive in 1999, started therapy shortly after, initially vith Videx 400 mg)-Viramune-Zerit. A resistance test done initially was showing no resistance to any drug. In these years I have been doing fine. VL constantly <50, T4 ranging 500-700. In May 2003 in accordance with my doctor we changed therapy in order to reduce lipodistrophy. New therapy is Videx (250mg) Viread and Viramune. At the time a new resistance test was done showing resistance to all NRTI and NNRTI (with exception of Videx and Viread) and no resistance at all to all PI group. Recent lab test are still ok: VL<50 T4 580. Bottom line : I keep having good lab test even tough I am resistant to Viramune. Should I change Viramune with a PI, in this case which would you suggest, considering that Trigliceridi and cholesterol are ok at the moment. Or should I continue with this meds, in such case untill when ?? Grazie !

Response from Dr. Sherer

I can't advise you to make a change in your regimen on the basis of the information you have provided, but I do advise that you work closely with your doctor over the next few months to answer the questions you have raised.

Some of your history is surprising, and leads to questions: First, how did you obtain a resistance test if your VL was consistently below 50 copies/ml?

Second, why was a resistance test done at all, if the only reason for the switch was avoidance of toxicity?

I am concerned, however, that if the resistance test results you cite are true, and the results truly belong to you, that you will see virologic failure in the near future, and that the consideration of a PI containing regimen is appropriate.

As above, I suggest that you talk to your doctor about these issues, and that you repeat these tests to ensure that the results belong to you, rather than a laboratory error.

Replcation capacity
Phenotypic testing

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