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mutations treatment naive
May 7, 2007

Dr. Sherer

I know I really shouldnt' be using this forum to ask questions as I'm treatment naive but infected with a virus from someone who likely was treatment experienced.

Not on meds, numbers are currently just "ok", soon may need to be. VL's below 6000 and CD4 311-500 curently 351, %'s 30-40 No co morbid pathology. Mid 50's infected since 2004.

These are the mutations

RT: K20R, M41L, K101Q, Q102K, K122E,I135R, C162S, Y181C, Q207E, R212R/K, T215D, H221H/Y, K223K/R, V245K, R227K, L281I, L238I, R284K

PR: T12P, R41K, Q61E, I64V, C67Y, H69Y, I72V

RC 21%

When the time comes, what ART regimen would you suggest.


Response from Dr. Sherer

This is an important question. I suggest that you take my suggestions to your next doctor's appointment to talk through them. There may be other issues that I am not aware of that would influence your choice of initial therapy, e.g. other medications you are on, other conditions, etc.

Most of the mutations are polymorphisms with relatively little impact, but, as you suggest, there are some important mutations to take into account, as follows:

NRTI: 41, 181, 215 PR: 67, 72

I would recommend that you and your doctor get a phenotype test to complement this genotype, as you may learn a little more about the actual responses of the nucleoside drugs and the PIs to your virus.

In any event, you have the Y181C, which means that efavirenz and nevirapine are unlikely to be active. I would avoid the NNRTI class for now, although there are second generation drugs that may be useful in future.

Thus we are talking about a protease inhibitor for intial therapy, and there the most common choices are lopinavir, atazanavir, and fox-amprenavir, all of which can be used once daily.

You also have some nucleoside mutations, but you should be able to get the full benefit from Truvada, which is co-formulated tenofovir and emtricitabine, which would be my first recommendation.

Together, these choices would mean four or five pills once daily, with a good expection of a durable response and minimal side effects.

As above, I suggest you talk to your doctor about these suggestions.

Does superinfection really exist?

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