Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.


Question:

Resistance to NRTI (Nucleoside Reverse Transcriptase Inhibitors) and NNRTI (Non Nucleoside Reverse Transcriptase Inhibitors) -- possible resistance to PI (Protease Inhibitors). If someone has extensive resistance to both these class of drugs, are there drugs in the pipeline to offer hope or are they doomed?

Answer provided by:

Mark H. Katz, M.D.
Regional HIV/AIDS Physician Coordinator
Kaiser Permanente of Southern California


There are several things to think about if you are stated to have multiple resistance:

First of all, what are the tests which led to the statement of "extensive resistance"? Are they to every drug in a class, or to just one or more?

The newly approved FDA-drug, Fuzeon (T-20) may be helpful as part of a regimen for someone with mutiple resistant organisms, although it is likely to fail itself if not used with other drugs to which the virus has sensitivity.

As for the specific classes, if you are resistant to one NNRTI, you are likely resistant to all 3 within that class. For protease inhibitors, if you are resistant to one, you might be resistant to others (this phenomenon is known as cross-resistance), but then again, may still have other options within the class. (Specific genotypic and/or phenotypic resistance testing can answer these questions.)

For the NRTIs, or nukes, here to resistance pattern is the least overlapping--i.e. you can be resistant to one or more and still have other options.

Best news of all, there are drugs in all 3 classes right now which appear to work against virus which has become resistant to the other members in their respective classes. Tipranavir, for example, is a promising protease inhibitor which appears to have activity against virus which has become resistant to all currently used PIs.

Good luck!


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