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Strange resistance
Nov 1, 2001

I'm an italian boy 24 yo. I have been on azt+3tc+efv for two years.

This are the average data of two years therapy: CD4: 1000-1200 VL: <200-300

The last result on 7th september were cd4 1126 vl <200. The same day doctor decided to stop treatment for psichiatric effects of sustiva.

After 15 days without treatment i made a genotipic resistance test with these results: Mutation: 103n 108i 118i 184v

CD4: 890 VL: 11000

It sound strange because the test say that i'm resitent to efv and 3tc.

How is possible that in spite the resistance the combo worked for two years.

Which is the best combo now without using a protease inibitor?

Thanx a lot and sorry for my english.

Response from Dr. Little

I would agree with you that to have a genotype test which seems to indicate resistance to 3TC and sustiva (EFV) when you have been taking these with complete suppression for several years does not make a great deal of sense. Unless there are times when you have missed doses and your viral load has been higher, I would be quite surprised by these results. My first thought is to repeat the resistance test. While I know these are expensive, this test result may have significant consequences for your future therapy and it seems worth the expense to find out if it is true.

Regarding an alternative, non-protease regimen, I am not sure I can make a very good recommendation. With the K103N mutation, your response to all the non-nucleosides is expected to be poor. I do not know what your pretreatment viral load was, but perhaps if it was quite low, you could consider a 3 nucleoside regimen with Abacavir, ddI, d4T or Tenofivir. You do have a very high CD4 cell count and could certainly afford to wait and see how high your viral load rises - you may choose to stay off therapy for a period under VERY CLOSE observation to see what your risk of progression is likely to be. Good luck.


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