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Resistance testing-how much and do i need it?
Jun 24, 1999

After 2 years on D4t and 3tc, viral load has gone from <500 to 30,000. CD4 went from 200 to 300 and is holding there. My doctor suggest that I go onto Combivir and Viramune. I decided to do some homework for the first time in a long time and discovered resistance testing. Is resistance testing indicated here? From what I've read, it would seem to me that this change in therapy (replacing D4T with AZT) is really just guessing, it could be the 3TC to which I'm resistant as easily as it could be the D4T. Or is it likely that I have resistance to both at this point. What is the price of such testing. I am of limited financial resources, but would pay for resistance testing if it was of great benefit in making a treatment decision at this juncture. Also, since AZT has been around so long ( I was infected in 1992) aren't the chances great that I already harbor AZT resistant strains? THANKS SO MUCH FOR YOUR TIME

Response from Dr. Holodniy

The test on the open market ranges from $300-500. If d4T and 3TC are the only 2 drugs you have seen, I would not recommend resistance testing at this time. You have a lot of options at this point and very little cross resistance potential. You are correct, it is very likely your virus is resistant to 3TC. Thus, you would be changing to only 2 active agents. Although it is unlikely that your virus is resistant to d4T, it would be unwise to keep it on board if you added AZT because of the antagonism between these 2 drugs. I would like to see a regimen for you that had 3 active agents. This will assure that your viral load gets to <50 from 30,000.

MH


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