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not really treatment naive
Mar 22, 2007

I'm treatment naive but have "inherited" a resistant virus. Phenosense GT showed resistance to all NNRTI class. The game plan was to start norvir/reyataz/truvada. Then the Stanford mutation database indicated that in addition there is low level resistance and moderate level resistance to all the NRTI's except for 3TC and Emtriva. No resistance to any PI's. My CD4 levels have dropped to between 300 and 350 on two month apart tests.

So what do I do? What regimen is left to take?

Response from Dr. Daar

Thank you for your post.

Your question raises several very important issues. First it illustrates the importance of drug resistance testing being performed prior to the initiation of therapy. Clearly there are people who are acquiring drug resistant virus and by knowing this providers are able to select a more appropriate regimen. The good news is that there are many available options and regardless of the initial regimen, most people can be effectively treated.

The other important issue your posting raises is the complexity in interpretting drug resistance tests. Both genotype and phenotype testing have limitations and while they provide an interpreation to assist the provider, it does require a certain level of understanding and expertise to optimally utilize the results. In your case it would be very helpful for me to know what mutations are actually present in reverse transcriptase in order to determine the actual level of resistance you have to the various NRTIs and NNRTIs. Based upon what you have outlined, it is likely that a ritonavir-boosted protease inhibitor will be part of your first regimen, but without the actual genotype data I would be reluctant to comment on which NRTIs you migh use with it or whether NNRTIs are completely out of the question.

I would encourage you to discuss this further with your expert provider and if you would like, to make another posting with the actual mutations on your report, after which I would be happy to comment further.

Best, Eric


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