Virologic's phenotypic analysis showed the patient's virus was resistant to two reverse transcriptase inhibitors: zidovudine (AZT) and lamivudine (3TC), and four protease inhibitors: saquinavir, ritonavir, indinavir, and nelfinavir. In addition, the researchers evaluated the viral genotype of the patient and the partner to determine whether mutations associated with resistance to anti-retrovirals were present. The patient's virus had four mutations associated with resistance to reverse transciptase inhibitors and seven associated with resistance to protease inhibitors.
Evaluation of the partner's virus showed many of the same mutations, while other genetic tests showed the virus in the patient closely matched that of the partner.
Because this patient's virus is resistant to many anti-retrovirals, typical drug combinations are not working as well as for other patients, Hecht said, but other treatment options still exist.
"This case doesn't mean that combination therapy is not a good thing," said Thomas J. Coates, PhD, director of the UCSF AIDS Research Institute. "A lot of people are living longer and better lives due to combination therapies, but it is clearly not the final answer. We have to help the afflicted communities understand that transmission of resistant strains is possible, even by a practice not considered to be very risky."
The patient was a part of the UCSF Options Project, a study evaluating the usefulness of combination therapy started soon after infection. The project is directed by James O. Kahn, MD, of the UCSF AIDS Program at San Francisco General Hospital.
Co-investigators in this study from the UCSF Gladstone Institute of Virology and Immunology are: Robert Grant, MD, MPH, staff research scientist and director of the UCSF/Gladstone Core Virology Lab; Laura Digilia, MD and Nirmala Bandrapalli, MS.
Other co-investigators are Beth Dillon, MSW, MPH, and Bernard Branson, MD, from
the Centers f
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Contact: Mitzi Baker
mabaker@itsa.ucsf.edu
(415) 476-2557
University of California - San Francisco
1-Jul-1998