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2 regime only
Sep 10, 2001

Doctor! how are far can 2 drug regime (2 NRTI only) last before the drug resistance forms? Because in a poor country like our peolple cannot afford the recommended doses of 3D-regime. Can HAART be of 3 NRTIs instead of 2 NRTI - 1NNRTI or 2NRTI - 1 PI? Or can it be of 4 NRTI?

Response from Dr. Aberg

There have been several studies demonstrating that combination therapy with two nucleosides (NRTI)and a protease inhibitor(PI) is better than 2-NRTIs alone. By better, I mean that more people achieved undetectable HIV viral loads in their blood and it stayed undetectable for a longer time. There are also studies showing that 2-NRTIs and a non-nucleoside (NNRTI) may be as potent as 2-NRTIs and a PI. And as you suggest, even 3 NRTI's. I have not heard about using 4-NRTIs and I would be concerned about side effects from using 4 together.

You are from a country that cannot afford to give everyone with HIV triple therapy. I will not get into the politics here but I do think 2-NRTI's is a potential option in countries with limited resources. No, it is not ideal but we also have seen studies in which up to 60% patients had low to undetectable viral loads for 1-2 years. There are always exceptions and I think many USA providers still have patients on 2-NRTIs because the patients want to stay on that combination and they are doing well. I have a few patients who have been on 2-NRTIs for several years and have totally suppressed virus. Until better and more cost effective therapy is available, 2-NRTI therapy may be a reasonable alternative. This therapy will prolong life and reduce illness in the short run until better alternatives are available. There is a risk of resistance. The most important advice I can give you is that if you do decide to take 2-NRTIs, make sure you take your medicine all the time. The most common cause for treatment failure is missing doses.

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