Thank you for your post.
It would certainly appear that your patient has had an excellent virologic and immunologic response to his current therapy.
His genotypic resistance pattern would predict a lessened response to tenofovir (TDF), but also note that in the presence of the M184V mutation, TDF susceptibility is increased (even in the presence of K65R). Viruses that harbor K65R and/or M184V are known to have decreased
replication capacity ; as shown in this review from Dr. Cal Cohen on TheBody.com. It is tempting to conclude, therefore that the activity of TDF in your patient could actually be enhanced by the maintenence of viruses with M184V by using 3TC or FTC in the regimen. Additionally, since lopinavir/ritonavir is known to increase TDF exposure, another potential mechanism whereby TDF activity may be enhanced in your patient. So, I wouldn't conclude at all that your patient is receiving lopinavir/ritonavir monotherapy.
On last comment, the combinatin of TDF and ddI should be used with caution because of the increased risk of ddI-related adverse drug reactions. One reference to this comes from our analysis from the
HOPS cohort. At the least, because of the drug-drug interaction between TDF and ddI, the dose of ddI should be reduced to 250 mg (instead of the usual 400 mg).
Hope this helps, BY
