Dear Doctor

At first, I started taking AZT and DDI Jan 1997 and got drugs resistance July 1998. Then my doctor changed regimen to AZT, 3TC, and SUSTIVA August 1998. This regimen is upto now. July 2004 CD4 and Viral Load were 365(25%) and < 50, respectively. My health is so far so good, excepting problem on lipoatrophy(veiny arms & legs, and no muscle). It is not much serious though I execise 4-5 days a week.

My curiosity is to know the next regimen if the current one is failed.

Thank you for your kind help and wish you are healthy and prosperous

Best regards Thai Guy

I would need more information to provide a complete answer, so I will describe likely options based on your history, and ask that you discuss my comments with your physician.

First, I would want to know if a resistance test was done when you failed in 1998, though it is unlikely. I would also like to know your lowest CD4 cell count and highest viral load prior to treatment. It is difficult to know also what treatment options were available to you in Thailand in 1998.

Finally, I would say that your next regimen will depend on results of a resistance test at the time this current regimen fails, if such testing is available.

Having said all of that, your next regimen is likely to include one or more protease inhibitors, such as lopinavir/r, with or without one or two of the newer nucleosides with some activity against NRTI-resistant strains such as tenofovir or abacavir.