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HIV Drug ResistanceHIV Drug Resistance
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multiple drug resistance, poor response, cmv retinitis returns
Jul 26, 2001

I've been off antivirals now for 5 months, after genotype and phenotype show no viable combinations for me. Been through almost everything, resistant to most. CD4 is 34, vl is 433,000, and now CMV retinitis is reactivated. I'd like to avoid gancyclovir, after learning of the possibility of developing resistance, so I'm probably going to have an ocular implant, which would treat site specific, without masssive dose which could cause resistance. Am I right in my thinking?

Response from Dr. Feinberg

No. CMV is a systemic disease, which means that virus can be found throughout the body, not just in the eye. Studies of the ganciclovir implant have demonstrated a real risk of disease elsewhere-- including the untreated eye-- because the only place that CMV is suppressed is the eye with the implant. Also-- resistance can develop to any of the drugs used to treat CMV. I don't know what your previous CMV treatment history was-- if you had prior ganciclovir and are now having recurrent retinitis because your HIV is no longer controlled, that is a different situation than if you are experiencing recurrence despite ongoing CMV therapy. I suggest that you discuss the specifics of your situation with specialists in both HIV and CMV retinitis to come up with the best possible approach for you. Good luck!

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