Hello Doc: I need your help. I have the followings mutations (Virco test):

NRTI/NtRTI:74V,181C,184V,211K,214F,386I

NNRTI:103wt/R,135T,179D,181C

PI : 41K,63P,77I

Emtriva, Viramune, Sustiva: Resistence Epivir,Ziagen: Minimal Response Videx: Reduced Response.

AZT, Zerit, Viread, ALL PI: Maximal Response. ------------------------------------- My first Combo:Abacavir+3TC+ NEvirapina. I interrumped this twice, then the resistence.

My second and Actual Combo: KAletra + Tenofovir + AZT. Excelente adherence and undetectable VL since 1 year.

------------------------------------ My cuestion: I notice signs of lipoatrophy. Y need to change AZT to 3TC. My doc accept it but he tells me that the potential new regimen (Kaletra + 3TC + Tenofovir) can only mantain me undetectable only 2 years....

What is your opinion about??

Please, I need your opinion....

THANK YOU VERY MUCH!!!!

Stopping AZT would be stopping an active drug, but it may be contributing to toxicity.

That leaves 2 active drugs...Viread and Kaletra. NOw Kaletra as a fully active "boosted" PI is a very potent drug. There have been studies that show that boosted PIs can maintain viral suppression in many people even if the other drugs are stopped (that is not recommended, but they are potent).

The M184V mutation makes Viread a stronger drug. So keeping it around (and 3TC will help keep it around) may help. Lastly, while your virus is 3TC resistant, it may still help a little by keeping the virus unfit to infect new CD4 cells.

It is not unreasonable to try. Since your virus has been suppressed for so long it has a good chance of working, and if so there is no time limit on how long it would work. The regimen would require very strict adherence and very few missed doses.

Good luck,

Joe