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Taking Atripla with past resistance to Sustiva



 I am just wondering about taking atrila as my med options are running out. I am currently on Fuzeon but I think I could be resistant as I had missed a few doses because of the severe Injection Site Reactions that even the Biojector did not solve. I at one time took sustiva and became resistant and at that time I was told that once you are resistant to Sustiva  you are resistant to it and the other to drugs in the same class. Just wondering if the thinking on that maybe has changed and Atripla may be an option for me?

 I am also taking Truvada, Aptivus and Norvir with the Fuzeon now. I am thinking a new genotype might be in order to see what the levels are at as the last one over a year ago showed resistance to evrything with minor resistance to just a couple of meds at that time.

 Anyone else in this same situation?



Hello Loyd, welcome

The short answer is "No".  If you are resistant to Sustiva then Atripla adds nothing in terms of options.

However, the long answer is "Maybe".  It depends on your viral population now. Resistanc to Sustiva fades into the background quickly, and can lurk unnoticed (and un discoverable) until you take an NNRTI like Sustiva.  After time though, perhaps 5 years, it may fade completely though, there is some evidence for this.  Therefore Sustiva, as part of a "salvage" (hate that term) regime may have a role.  Depends on your resistance profile and the other drugs you decide to use.  It may not be a best option, and it maybe only a short(ish) term option, but it may be viable for now.

It is really hard to say anything definite without knowing the details of your genotype and phenotype resistance tests.

Darunavir (TMC-114, Prezista) is a new PI, which looks like being good on beating resistant virus into the ground, is now available, and maybe an option.  But it's hard to say without knowing your resistance test results whether it would be viable for you.

- matt


 Well my last resistance test showed nearly every drug I am resistant to but a couple of them I have minimal resistance but my doctor also did some test that gives a percentage of the virus replication or something like that and I was in the 10% range which he said was very good and may mean that eventhough I am showing resistant to most of the meds that they still may be working . my viral load has generally been very high and reduced from 450,000 to 25,000 then to 5,000 them to 700 after startinf Fuzeon in October of 2005 but by January the viral load went up to 15,000 then 25,000 then 50,000 and I will get my next labs next week and that will determine whether or not I will be stopping the fuzeon and possibly continuing on with the Truvada, Aptivus, and Norvir for the time being. I have been looking at a trial that is out there for an oral entry inhibitor called SP01A and hope that maybe that could be an option.

 I do know that with the severity of the Injection Site Reactions and am going to miss more doses. I even switch in between the needle and the biojector but that still doesn't lessen the reactions and the reactions seem to get worse and last a lot longer. the biojector reaction in the side of the stomach lasts for 4 to 5 days and the needle reaction lasts just as long and sometimes I get a really bad bruise from the needles that I once did not and I am injecting as I always have.

 But since my viral replication is low my doctor may keep me on the meds I am except fuzeon and may add the new PI. My t-cells have pretty much been stable except just before starting the fuzeon when it dropped below 100. It is now in the 400 range and that is pretty much where it stays.

 Hopefully, since they came out with this one pill a day regime they will come out with one that doesn't include the class that sustiva is in since I believe there is still just the 3 drugs in that class.

 Thanks for the response.


I posted a longish reply on TMC114.  It got shafted when I hit Return. But the info is in the attached poster (PDF) from the recent BHIVA conference. 

Short version, there seems to be a poor correlation between number of primary PI mutations at baseline and virological response to TMC114, and many pople using it got VL down to under 400 or even under 50. If you have 10 or less primary PI mutations it may be useful.

- matt

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