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Case 3: Resistance to Non-Nucleoside Reverse Transcriptase Inhibitors

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D If the patient is placed back on efavirenz and the K103N mutation remerges, efavirenz should be continued because the presence of the K103N mutation will markedly reduce viral fitness.

This answer is incorrect. The K103N mutation causes high-level resistance to efavirenz, but does not appear to significantly affect virologic fitness. Continuation of efavirenz in the presence of K103N is unlikely to be of benefit, and may lead to emergence of additional NNRTI mutations.

A The patient is not likely to have a significant virologic response to efavirenz or nevirapine.
B Although the K103N mutation reflects resistance to efavirenz, the patient should have an excellent virologic response to nevirapine.
C Although the K103N mutation reflects resistance to efavirenz, the patient should have an excellent virologic response to delavirdine.

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