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The World is not flat! Safer sex must be the rule!
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written by Bruce Polsky, M.D.
published on HIVresistanceWeb: March 15, 1998
It was only a matter of time before a report like this one, by Imrie et al, was published. Patients who are on antiretroviral agents can and do transmit multiple-drug resistant HIV. Previous reports have documented the transmission of AZT resistant virus. This report extends the observation to include HIV that is dually resistant to nevirapine and AZT. Given the widespread use of protease inhibitor
containing regimens, and the resumption of unprotected intercourse,
it is only a matter of time until protease inhibitor-resistant isolates are transmitted and reported.
This report reminds clinicians that all patients, including those who are "fully suppressed", must be consistently counseled to practice safer sex. It also begs that question of whether newly infected patients should be routinely genotyped in order to to
identify drug-resistant HIV isolates. Since the first drug regimen given to a patient is often the most important, choosing a regimen that contains drugs to which the patient's HIV isolate was already resistant would be unwise. For example, based on the CAESER trial results, some clinicians might be tempted to treat a newly infected patient with a combination of AZT,ddI, and nevirapine. In this
particular case, since the patient's virus is already resistant to
AZT and nevirapine, we would actually be prescribing ddI monotherapy. While there are problems with routine HIV sequencing, its use in new infections may be supportable depending on how common
drug-resistant isolates come to be in the community.
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