Ask Your Colleagues About:

Treatment Strategies
  

Primary Resistance now nees treatment

Posted: Oct 26, 2006

QUESTION:

This patient is treatment naive but genotype testing with the vircoTYPE test indicates he was infected with a virus with multiple mutations. Known to be HIV positive since December 2005, Healthy, working full time, 50 years old, cd4 231 now and ranging from 333 to 275 for the past 10 months. VL stable at 10000. Mutations are NRTI: 41L,43E,67G,70R,181C,211K,215V,219Q,221Y NNRI: 98G,103N,108I,181C,190A,221Y PI: 10I,20R,35D,36I,63P,90M,93L

He is resistant to all NNRTI's. The other classes range from reduced response to maximal response, with maximal PI response to kaletra. So I was thinking of Kaletra with two NRTI'S but the question is which ones. Any advice apreaciated.


  

RESPONSE FROM:   

    This is an awful genotype and I am amazed at the number of mutations across the board. I find it hard to believe this is a treatment-naive patient.

    If you live in the US, I would use darunavir/ritonavir plus try to get the patient into expanded access program for the Merck integrase inhibitor (they may not let you because he is not treatment experienced - but you can try). To this I would add Truvada and AZT. It is possible these NRTIs will have some antiviral effect and will also reduce viral fitness.

    If no integrase, I would then opt for the darunavir/ritonavir+Truvada+AZT and also discuss with the patient Fuzeon (perhaps only until the integrase is approved then you can switch to that from Fuzeon).

    TMC-125, the new NNRTI might have some effect here but it will be limited given the resistance pattern.

    Let us know how this works.

    DW




Terms of Use: Please remember that this forum is designed for educational purposes only, and experts are not engaged through this forum in rendering legal or medical advice or professional services. Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Questions and messages posted to this forum are not statements of advice, opinion, or information of The Body PRO, Body Health Resources Corporation or any sponsor of this forum.

Visitors submitting questions remain solely responsible for the content of their messages. Information provided by experts is general only and should not be used for diagnosing or treating a health problem or a disease, or relied upon as legal or other professional advice. This information is not a substitute for professional advice or care.

powered by ExpertViewpoint

global Toolbox