January 13th, 2009

Can We Have “Too Many Options?”

As part of our regular series “Antiretroviral Rounds” in AIDS Clinical Care, today we post a case of a highly treatment-experienced patient with dreaded “triple class” resistance — that is, resistance to NRTIs, NNRTIs, and PIs.

The good news now, of course, is that we have more than these three drug classes.

The tough part is choosing what to use, as often with so many new options we’re designing regimens that have not been extensively tested in prospective studies.  (Or tested at all — for example, no patient in the maraviroc MOTIVATE studies received darunavir; today I’d suspect nearly every patient on this drug is on darunavir.)

We asked three highly-experienced HIV specialists what they’d do for a patient like this with “too many options” — raltegravir-naive, R5 tropic virus, susceptibility to both etravirine and darunavir — and perhaps not surprisingly, we got three different answers.

Further input to management of this case is welcome, of course.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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