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HIV Drug ResistanceHIV Drug Resistance
           
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Combivir and Sustiva
Apr 29, 2001

Is there any concern about taking Sustiva and Epivir together, since they are both "one-mutation away" from resistance medications? Or does daily adherence to the pills obviate this concern?

Response from Dr. Little

The use of sustiva and epivir (3TC plus AZT) is an excellent regimen in a treatment inexperienced person (ie no prior therapy). The treatment response data are quite good as long as there is no pre-existing drug resistance (which would in effect reduce the number of truely "effective" drugs in the regimen, despite swallowing all the pills faithfully). It is true that the 3TC and sustiva have a lower barrier to drug resistance than other drugs (ie they require only one mutation each to result in drug resistance), but if you take 100% of your pills faithfully, this should not be an issue. This is a very popular, very effective treatment regimen. The only time I am less likely to use this combination, is in someone with an extremely high viral load (perhaps greater than 500,000 copies/ml), if they are very uncertain of their ability to take the therapy effectively, or if there is pre-existing drug resistance. Obviously, no one can predict that adherence with drug therapy will be in the future, but if you have the intention to take every dose and discuss side effects which may make you less likely to keep your medications down (ie nausea and vomiting) or fears about taking antiretroviral medications with your doctor, then I would say this is an excellent choice for most treatment inexperienced individuals.


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