The [him] moderator has received the following request for advice from a reader. You can contact the reader directly at the email address given below or contact the [him] moderator at HIV.Information.for.Myanmar@gmail.com and your reply will be posted without your name on the blog and email list.
[him] moderator
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I was caring for a girl with HIV/AIDS for over two years. In that time her CD4 count went from a low of 67 to nearly 300 – that was after taking ‘Trovir’. Unfortunately, I lost contact with her for over a year. During that time she stopped taking the ARV for a period of about 8 months. She recently returned and is very thin and weak. At present, she is being taken care of by Phyu Phyu Thinn and her dedicated team of volunteers.
My question is – what is the likelihood that the Trovir that she has now resumed taking will be ineffective? It seems that we have to wait for blood tests to confirm this and this could take up to 6 months. (She will have a CD4 test today). My worry is that she may not survive that long. Isn’t it safe to assume that the first line drugs will not work and start immediately on a second line treatment? Maybe someone out there has been in a similar position? I am not even sure how available such a second line treatment is in Burma and I know it is expensive.
Any advice would be gratefully received.
Davie
davie.channon50@gmail.com
First a couple of clarifications. How old is this person? And is the
generic name of the "Trovir" medication she was taking zidovudine or
azidothymidine or AZT?
If she is an adult who took zidovudine monotherapy for two years
regularly and stopped abruptly, her virus may not be fully resistant
to zidovudine. It will certainly be partly resistant. The current
practice is to treat with a minimum of three drugs at one time. She
needs these three drugs right away.
The first line drug regime used in the national AIDS programme are
stavudine plus lamivudine plus nevirapine or zidovudine plus
lamivudine plus nevirapine. The alternative first line regime is
stavudine plus lamivudine plus efaviraenz or zidovudine plus
lamivudine plus efavirenz. She should start one of these three-drug
cocktail regimens right away. Ideally the cocktail should not have
zidovudine in it but cost and availability are going to determine her
decision more than choosing the ideal cocktail.
I wouldn't wait for the CD4 count result as it is going to be low and
will almost certainly not affect the decision to treat her
immediately. I wouldn't do the resistance testing at all.
Posted by the [him] moderator:
The answer to your dilemma is that you should put her back on the Trovir (if this is a 3 drug combination pill) because she may not have a resistant virus. If she stopped it completely instead of taking sporadically, she may not have developed resistant virus. So try it again.
You are also correct to assume that very little 2nd line is available in country and if you can find Lopinivir/retonovir you will pay a lot for it. So you probably have little choice in any case!!!
Dr. Moore
ARV physician working in country