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HIV Drug ResistanceHIV Drug Resistance
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about resistance
Aug 5, 1999

mark, 1)if you show resistance to certain nukes such as AZT and 3TC, can you still use them in the future or currently with an nnrti or pi? 2)isn't it true that in order for a resistant strain to appear, hiv must mutate into a cell that goes around all three drugs that you are using? 3)so if this mutated cell/strain does prevail/occur, wouldn't it be resistant to all the drugs you are on? 4)or am i wrong in that hiv needs only to mutate around one or two barriers (such as 2 nuke barriers or 1 nuke and 1 nnrti) so that viral load will go high again (above detection)? Lastly, i always here about people being resistant (or at least slighty) to many nukes but still use them successfully in haart regimens. 5)does this mean that nuke resistant isn't as important to resistance to nnrti's and pi's? I am lead to believe that the main goal is to avoid resistance to nnrti's and pi's and that resistance to nukes aren't that great a loss? Please answer my 5 questions so that i better understand what will occur after i start treatment. I plan on going on sustiva, ddi, abacavir, and hydroxea; i heard it's a solid combo and saves the pi's - any comments to this combo?

Response from Dr. Holodniy

1. It would be unlikely they will have long term effectiveness. 2. Not necessarily. At least at the level we can measure, you might be resistant to 2 of 3 or 2 of 4 of the meds you are on. 3. See 2. 4. See 2. 5. One mutation can cause class resistance to NNRTI. One or two mutations can cause significant PI cross resistance. Although there are some class NRTI mutations, they are rare. Thus, it is much rarer for broad NRTI resistance to develop. Love the regimen. MH

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