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HIV Drug ResistanceHIV Drug Resistance
          
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Pre Resistant to Sustiva
Jul 16, 2006

I received my resistance results back and found out I am resistant to all of the Non-Nukes and AZT out of the Nukes. It concerned me a bit, because I was hoping for once a day dosing. My Tcell is at 895 and viral load is 70,000. My doctor does not want to start me on meds for a bit, because my tcells are so high. But, I would like a second opinion on what you think the first line of meds would be? Do I still have a lot of options? I would appreciate any insight and thank you for your time in advance.

Response from Dr. Sherer

This is a good idea, i.e. to explore what treatments are available to your long before you start on ART. Be mindful that any anwswer today might change if and when the time arrives to resume treatment.

Yes, you still have good options, in spite of resistance to the NNRTI class and AZT (and D4T, i.e. when you are resistant to AZT, most often you are also resistant to D4T). But I don't have enough information to answer the question of all available options completely; I would need to know all previous regimens and responses to those regimens (including toxicities), results of your resistant test or tests, all other meds and medical conditions, and other information. So thats the limitations of an on line opinion - it will not be any where near as well informed as your own physicians.

I agree with the current HHS Guidelines thresholds for starting ART, i.e. viral load over 100,000, and CD4 cell count below 350 cells/ml, so I also would not advise starting ART at this moment, but rather obtain follow up viral load and CD4 cell count tests every 2-3 months for the next 6-12 months, until I got the sense of the current trends in those values over time.

On the basis of the information you gave, there are several viable once daily options for you that include a protease inhibitor. Of available protease inhibitors, the most commonly prescribed once daily are Reyataz (atazanavir), given with 100mg of ritonavir to boost the levels, hence 2 pills once daily; Kaletra (lopinavir/r), which contains ritonavir, 4 pills once daily; and Lexiva (fosamprenavir), also given with ritonavir, so three pills once daily.

I will note some NRTIs combinations that may be available to you, but I would need to know the exact resistance test results to be sure: truvada (tenofovir + emtritabine) one pill once daily; epzicom (abacavir + lamivudine) one pill once daily; and Videx EC (enteric coated DDI) + either lamivudine or emtricitabine, 2 pills once daily.

I urge you to take this list and these suggestions to your doctor for further discussion.


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