I've been hiv+ for over 15 years and never had any major OI's. I started azt in 1993 and then added 3tc in 1996. My tcells been in the 500-700 range until the last year. Now they are in the mid 400's. My viral load has never been undectable but has generally increased over the years. For the past three years it has ranged between 30-70k. I have resisted making any changes due to possible drug side effects. I had a genotype test about a year ago and it showed a slight resistance to both of the drugs. I am having difficulty maintaining my weight and want to know what drug alternatives I have? Can I still use any of the Nuceosides plus viramune or sustiva? I would like to stay away from protease inhibitors if possible. Please advise

It is very likely that your virus has developed drug resistance to the AZt and 3TC. As long as the virus can grow in the presence of the medication, it can select for more and more drug resistance. It is possible for AZT and 3TC to select for broad resistance to all the nucleosides. It would depend on which mutations were present. The other classes..viramune, sustiva, protease inhibitors, integrase inhibitors and possibly CCR5 antagonists would still be options. The key is to have enough active drugs to combine together. If your nucleoside options are limited you may have to use PIs to get enough active drugs. You should go over all your options with a specialist to plan a new therapy, especially since your CD4 count is dropping.

Best, Joe