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Case 4: Resistance to Nelfinavir

You answered:

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.

This answer is incorrect. The D30N is the most common protease-inhibitor mutation to develop early among patients who have virologic failure on nelfinavir. Although the L90M mutation is also common with nelfinavir failure, it occurs less frequently than the D30N mutation. The L90M mutation is more likely than the D30N mutation to cause cross-resistance to other protease inhibitors.

Choose another answer:

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