Doctor Oversight, Drug Resistance
Jan 3, 2013
Has HIV become resistant to the ARVs I'm taking now?
Like many other medical clinics or hospitals, the one I go to has experienced doctocs and inexperienced ones.
Around early November 2012, a doctor told me to start taking ARVs. The ARVs were Nevirapine and LaHIVudine/Zidovudive. My CD4 was 169 then (that's my latest). I was given those meds enough for 14 days as trial period. I came back after 13 days supposedly for refill because I didn't encounter any problem (no rashes, no problem). However, the doctor that saw me that time during the "refill" come-back was a more experienced one and found that I should not be taking Nevirapine, in the first place, because I'm taking Rifampicin. I have been diagnosed with PTB before HIV and have been taking PTB meds since August 2012. He canceled my Nevirapine refill request right away and gave me Efavirenz instead. I have been taking Efavirenz since then.
My question is whether or not the HIV in my body have become resistant to LaHIVudine/Zidovudive, and now resistant to Efavirenz. I've read somewhere before that, in order for the HIV to not be resistant, one should be taking at least 3 different drugs. If Nevirapine has become useless when I was taking it because of the Rifampicin, it means that during that time, I was essentially taking only LaHIVudine/Zidovudive, and the virus has become resistant to it (because not 3 drugs). And when I switched to Efavirenz, I was essentially taking only that (considering the HIV have become resitant to LaHIVudine/Zidovudive), which made the virus resistant to it, as well. Am I correct?
Has the HIV become resistant to all of the kinds of meds that I've taken and I should now switch for different ones altogether? I'm really worried. I won't have my CD4 test again until May 2013.
Response from Dr. Henry
Taking nevirapine with rifampicin decreases the nevirapine levels by 50-60% so it would be much less effective. Two weeks of lamivudine + zidovudine only occasionally would result in drug resistance-adding the efavirenz after two weeks was a good idea. It is possible that resistance could have developed but most patients would not develop significant resistance with the scenario you describe so I would be cautiously optimistic that you will do OK. KH
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