|Re: Not really treatment naive
Apr 9, 2007
Dr. Daar, As I stated previously I'm treament naive, also probably infected early 2005. mid 50's in age. These are the mutations listed on the PhenoSense GT report On the first page NRTI mutations: M41L,T215D NNRTI: K101Q, Y181C PI: NONE
On the third page of the report is a complete list of mutations
RT: K20R, M41L, K101Q, Q102K, K122E,I135R, C162S, Y181C, Q207E, R212R/K, T215D, H221H/Y, K223K/R, V245K, R227K, L281I, L238I, R284K
PR: T12P, R41K, Q61E, I64V, C67Y, H69Y, I72V.
replication capacity listed as 21%
I would really appreciate your input on what regimens are available to me now that my CD4's have reached the treatment range.
Response from Dr. Daar
Thank you for the follow-up email with the specific information regarding your genotype. Based upon this your virus is likely to be partially resistant to several NRTIs and NNRTIs. While your options may be somewhat more limited than someone who did not acquire drug resistant virus, it is great that this was discovered early since there remain several options for you.
At this time most options would be built around the use of a ritonavir-boosted protease inhibitor with NRTIs that would likely include tenofovir and either 3TC or FTC along with perhaps zidovudine and/or abacavir. A regimen like this would be a good start and likely to be very successful. Obviously you would need to be monitored closely to assure an appropriate response. It is also important to note that there are many additional options for the future, including but not necessarily limited to enfuvirtide (T-20), integrase and CCR5 inhibitors.
Please understand that my comments are just general concepts for your consideration. Ultimately you do need to discuss all options with your expert provider who can best take into account other unique issues you may or may not have such as underlying renal disease, hepatitis co-infection, cardiovascular risk factors, etc.
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