July #49 : Gene Pool - by Lark Lands

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The Power of One

The Power of One: Senegal

The Power of One: Uganda

The Power of One: Zimbabwe

The Power of One: Zambia

World Weary

South Africa's Moment of Truth

Back to the Roots

Chain Reactions: Medicine Woman

Chain Reactions: Poetic Justice

Chain Reactions: Ray of Hope

Chain Reactions: Reluctant Witness

Guest Editor's Letter

To the Editor

Bath Sides Now

Walk the Talk

Rubber Suit

Memo Demo

Dread Locked

PWAs vs. Y2K

Jail Break

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Gender Agenda

Simon Nkoli


POZarazzi: Spring Sprung

License to Kill

Keep HOPE Alive

POZ Picks

Show & Tell

The Holistic Truth

Get Over It

Sugar on Top

Cheer to Adhere

Gene Pool

Cream Puff

The Protease Prison

Out in Africa

Where to Find It

Grandma’s Recipe

Grace Under Pressure

Most Popular Lessons

The HIV Life Cycle


Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

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July 1999

Gene Pool

by Lark Lands

There’s a new numbers game in town: Counting mutations to forecast how well salvage therapy may work. A Swiss study recently found that among 62 PWAs whose HAART had failed, the only significant predictor of response to a new regimen containing nelfinavir was the number of resistance mutations present before starting the new therapy.

Participants had been heavily pretreated, averaging almost three years on nucleoside analog reverse transcriptase inhibitors (NRTIs, or “nukes” of the AZT class) and more than a year on protease inhibitors (PIs). Three people had tried nonnucleoside reverse transcriptase inhibitors (NNRTIs). Using genotypic resistance testing, researchers found that nine out of 10 participants had NRTI resistance mutations at the outset, with four mutations the norm. An equal proportion had PI mutations, with the same median of four. NNRTI mutations were comparatively low—7 percent —but after all, only 5 percent of participants had taken that class of antiretrovirals.

Alas, no one with more than three PI or five RTI (either nuke or non) resistance mutations achieved a significant (greater than one log or 10-fold) drop in viral load within four to 12 weeks, the response designated to indicate success. No other factor—medical history, duration of prior antiretroviral therapy, number of drugs used, starting-point CD4 count or viral load—was found to be a significant predictor of response to the new combo.

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