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Case 4: Resistance to Nelfinavir

You answered:

A The D30N mutation will cause cross-resistance to atazanavir (Reyataz) and saquinavir (Invirase), but not to lopinavir-ritonavir (Kaletra).

This answer is incorrect. The nelfinavir-associated D30N mutation does not cause cross-resistance to any other protease inhibitor. The D30N is the most common protease-inhibitor mutation to develop early among patients who have virologic failure on nelfinavir.

Choose another answer:

B The development of the D30N mutation with early virologic failure is unusual in a patient taking a nelfinavir-based regimen. The L90M mutation is usually the most common initial protease inhibitor mutation to occur in this setting.
C Assuming that problems with adherence have been adequately addressed, this patient would have greater than 50% chance of achieving an HIV RNA value less than 50 copies/ml with a carefully designed subsequent regimen.
D Because of the unique resistance profile of nelfinavir, the 2006 DHHS antiretroviral therapy guidelines have ranked it as the preferred protease inhibitor to use in combination antiretroviral therapy in patients who have a CD4 count between 200-350 cells/mm3.

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