Dr., I have been positive for over 15 years. I started on azt and then added 3tc when it became avaiable. My cd4 counts have always been in the 500-600 range up until the past year. It has slowly declined to the mid 400's. My viral load which was staying in the 5-10k range has slowly crept up to between 30-60k in the past couple years. I have not wanted to change drugs because of possible major side effects. A resistence test showed some resistence azt and resistence to 3tc. I have had some hiv wasting and weight loss. I know I need at least two new drugs to change to. What would be your reccomendation? Thanks to your help.

Thank you for your question. You indicate that you have had a resistance test that showed resistance to 3TC (or lamivudine) and some resistance to AZT (or zidovudine). You and your doctor should discuss treatment options based on the resistance test results and the HIV medications that are available as options. For example, you only describe taking NRTIs (AZT and 3TC are part of the NRTI family of drugs). However, other HIV drug classes such as NNRTIs and Protease inhibitors (given with boosted ritonavir) would be reasonable considerations in a new regimen that you and your doctor discuss. In addition, other drug classes such as integrase inhibitors and entry inhibitors may also be options to consider. Which new NRTI that you may add as part of your new regimen would depend on the amount resistance you had developed to AZT.