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HIV Drug ResistanceHIV Drug Resistance
          
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drug resistance
Sep 1, 2005

i have just found out i am hiv+. CD4 count 280, have commenced treatment AZT. i am not resistant to any drugs according to the test done. i am told if my cd4 count is still 200+ i don't have to start treatment. will stopping treatment after birth cause resistance when i resume treatment in the future?

Response from Dr. Sherer

No, stopping the drug will not cause resistance. Rather, resistance has a real but low possibility (5-10%) of occurring for a different reason, i.e. you are on less than a fully suppressive regimen (which would be HAART, i.e. two NRTIs and either an NNRTI such as NVP (nevirapine) or a PI such as nelfinavir).

I gather from your comments that you are pregnant and receiving single dose AZT alone because you do not meet the WHO criteria for the initiation of ART, i.e. CD4 < 200. Many clinicians feel that when pregnant women receive ART, they should be treated with 3 drugs and not one, in order to both prevent transmission to the baby and to offer the best possible viral load suppression to the mother and to prevent the development of resistance. I agree with this position. If this were done in your case, and your CD4 cells were still above 200, the ART could be stopped safely, and then resumed when you reached the threshold for starting ART in your country.

It is possible that this option is not available to you. Please understand that I agree with the need for some ART to prevent transmission to your baby, and AZT is a good choice, especially if single dose NVP is added when you are in labor, and your baby receives treatment as well.

In most cases, following the use of AZT alone in pregnancy, women have been successfully treated with 3 drug HAART that includes AZT or another NRTI (HIV drug in the same class).

In sum: you have a real but low risk of resistance, but not because you will stop the drug, but rather because it is unlikely to fully suppress the replication of the virus. The use of AZT alone, or with single dose NVP is still highly valuable, and I agree with your doctors for treating you in this way. I urge you to talk to them about this answer and explore any options that may be open to you.

I wish you and your baby well.


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