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Apr 23, 2007

Dear Sherer,

Today I went to the doctor and he prescripted for me, AZT+3TC+TDF+LPV/r. My current drugs are AZT+3TC+EFV. The genotipic exam showed that my HIV has the following mutations: D67N, K70E, A98G, K103N, M184M/V, T215L and also L10L/I. Is this new choice the best one? I asked that since I read that mutation D67N and K70E are strongly related to AZT resistance. Why do I have stay with AZT on? I am looking foward to hearing from you. Best regards,


Response from Dr. Sherer

You are asking a useful question, and I urge you to take this response and your question back to your doctor.

There is a beneficial interaction between AZT and TDF in the presence of the AZT and 3TC resistance. Some additional activity for ZDV results when it is used with TDF in this setting. I suspect that your doctor is taking advantage of that interaction.

A reasonable alternative with that genotype is switching to a boosted PI and a new NRTI combination, so it would be possible to use LPV/r + TDF +3TC or FTC alone. A combination of twice daily LPV/r with once daily truvada (TDF + FTC) might allow for once daily dosing of the whole regimen once you have established effective control.

You might also ask your doctor whether he or she did a phenotype test as well, which can be useful with more complex NRTI mutational patterns like yours.

And finally, I would ask, why are you asking? If you have had some toxicity or side effects with AZT, such as nausea or headache, or if you are concerned about longer term side effects with AZT, you should discuss these concerns with your doctor, to ensure that he or she is aware of them, and to establish whether your concerns have merit.

only protease inhibitors are left
Discordant CD4 - CD4%

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