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Case 4: Resistance to Nelfinavir

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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.

This answer is correct. This patient has early virologic failure with limited drug resistance. Moreover, the nelfinavir-associated D30N mutation does not cause cross-resistance to any other protease inhibitor. This patient has excellent options available from each of the antiretroviral drug classes, which should make it relatively easy to construct an effective subsequent regimen. Available data have shown that more than 50% of patients who experience virologic failure on an initial regimen that consists of nelfinavir and 2 nucleoside reverse transcriptase inhibitors will respond well to a salvage regimen and achieve an undetectable HIV RNA.

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