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Monotherapy and Resistance
Apr 29, 2001

I recently read that: "Upon initiation of either nevirapine and lamivudine as monotherapy, high-level resistance emerges within days to weeks" This sounds so completely amazing. Does this mean that lots of people in Asia who are on monotherapy could conceivably be spreading around very resistant virus??

Response from Dr. Little

Monotherapy with lamivudine and nevirapine do typically result in the development of drug resistance within a period of weeks. For this reason, these drugs should be used with other potent drugs. It is also true however, that some therapy is probably better than no therapy. The issues relating to use of therapy in the developing world are very controversial and no one in the field has an easy answer. I will tell you that there are two sides to the discussion: 1. It is unethical to deny therapy to any infected individual and 2. Therapy that does not result in complete control of virus is likely to be associated with more frequent transmission of drug resistant variants.


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