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HIV Drug ResistanceHIV Drug Resistance
          
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Drug resistant
Feb 19, 2007

I am drug resistant to most drugs except for Kaletra. My doctor has orderd me a Truvada to use with Kaletra.My cd 4 count is 246. Ever since I took ArV's from 1999 to date, my cd 4 never exceeded 350. My doctor told me the virus that I have is difficult to treat. I would love to have a child in future when my cd 4 is up and viral load undetactable, are there any HIV medicines that are safe to use in pregnancy?

Response from Dr. Sherer

Yes, there are many HIV medicines that are safe to use in pregnancy. The amount of information available on the use of HIV medicines in pregnancy varies; in general, we have more information about the older medicines, such as zidovudine, lamivudine, and nelfinavir, which are all classified as among the safest. Kaletra has also been increasingly used and studied in pregnancy, with an excellent safety record, and currently is one of two recommended protease inhibitors (along with nelfinavir)for use in pregnancy.

Truvada, i.e. its two component drugs tenofovir and emtricitabine, is listed as 'insufficient data' in the pregnancy treatment guidelines, since they are relatively newer. This nucleoside combination is often chosen as a second line option,. I agree with your doctor that the first priority for your treatment is the best possible treatment for your health, and the uncertainties of the use of Truvada are outweighed by the need to provide you with the best possible control.

I urge you to talk to your doctor about the considerations for you to plan to have a baby. While the subject is complex, many women have made the same choice that you are considering.

Regarding your drug resistance, depending on where you live, some or all of the new treatments for HIV may be available to you and your doctor now or in the near future. I urge you to talk to him or her about these medications. They include new protease inhibitors (darunavir or tipranavir), in the event that Kaletra becomes less active in future; a new second generation NNRTI inhibitor - etravirine - for people who developed resistance to nevirapine or efavirenz; the new injectable entry inhibitor enfurvitide, and other new entry inhibitors such as miraviroc in the near future; and a new integrase inhibitor - MK-0518 - that should be available later this year.


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