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Case 4: Resistance to Nelfinavir

You answered:

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.

This answer is incorrect. Although nelfinavir is an attractive option from the standpoint of its unique resistance profile, it clearly provides inferior virologic response compared with lopinavir-ritonavir (Kaletra). In the 2006 DHHS antiretroviral therapy guidelines, lopinavir-ritonavir is the preferred protease inhibitor and nelfinavir is categorized as an alternative protease inhibitor.

Choose another answer:

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

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