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Case 3: Resistance to Non-Nucleoside Reverse Transcriptase Inhibitors

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A The patient is not likely to have a significant virologic response to efavirenz or nevirapine.

This answer is correct. The K103N mutation is the most common non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation to develop in association with virologic breakthrough in a patient taking efavirenz. This mutation causes high-level resistance to efavirenz. In addition, the K103N mutation causes cross-resistance to nevirapine and delavirdine. Because the K103N mutation is archived, it will likely reemerge if the patient is challenged with any of the NNRTI drugs, making a sustained virologic response to efavirenz or nevirapine unlikely.


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