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resistance to stavudine
Sep 27, 1999

Is there any data that explains why some patients experience clinical failure on a regimen containing stavudine if there are no clinically observed codon mutations linked to stavudine resistance?

Response from Dr. Holodniy

Good question and hard to get an answer. A couple of points though. Although we can't seem to find the mutation we believe causes d4T resistance in the test tube in people, we see the cases you describe. This may be related to other mutations that affect d4T activity (like AZT related mutations), novel nucleoside analogue class mutations (meaning it takes out all those drugs: AZT, d4T, etc), or cellular metabolic issues. In the latter case, some people have found that giving d4T after AZT was less effective than if d4T was given first. This may relate to changes in cell metabolism induced by AZT that renders d4T not as effective. MH


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