Fred........ some patients have become resistant. Some are going on two years without a hiccup. To make the leap and assume that all patients will fail is a huge, and thus far unjustifiable, leap. It assumes that there is a reservoir in the body where patients, despite compliance, can't get enough drug to keep resistant mutants from arising. Maybe the brain is such a reservoir, maybe not. Thus far, your conclusion is not justifiable. Furthermore, if aspartic ----> asparagine 30 *is* the predominant mutant ass'd with nelf and if this change does not lead to resistance to crix (go David, go!), saq, etc., then some compliant patients will just be able to flop between nelf and crix for the remainder of their normal lifespan.
Lots of ifs, but it's equally as risky to assume that all compliant patients are going to fail. We'll soon have a much better picture..... it seems like 50% of the world's scientists are sequencing resistant virus.
Two of your remaining statements are just plain wrong. Patients _are_ switching to nelf out of preference, much more frequently than from necessity (having failed crix, for expample). And, if the virus goes into "remission" (as it most often does), patients damn well better keep taking the PI until Dr. Ho has completed his experiments.
You're correct..... all PIs have thus far become ineffective **in a fraction of patients**.
Rick |
