A patient with no options?

A 44-year-old man diagnosed with HIV in 1992 has become 3TC-resistant, has had adverse effects to ddI, and most likely will have the same adverse effects to d4T and ddC. The Ritonavir, Saquinavir, and Nevirapine combination he was switched to did not reduce his viral load, however, the patient was clinically stable without wasting or opportunistic infections, and his CD4 count was 220 cells/mm3. Based on past responses to medication and to the available NNRTIs, it is believed that the patient is currently cross-resistant to all first-generation protease inhibitors. It was suggested that the patient, now categorized as having virologic failure but clinical/immunologic success, is unlikely to achieve durable suppression, even with the new drugs becoming available. Mega-HAART therapy, which uses up to eight drugs, may work temporarily but appears to be intolerable in the long term for most patients. It is not known how long the patient's clinical/immunologic stability will last, but it is unlikely to continue indefinitely in the presence of high viral replication. In the case of worsening conditions, it is suggested that a phenotypic analysis be done to guide salvage therapy. In the absence of a phenotypic analysis, it is suggested to try a combination of ddI plus d4T plus Hydroxyurea plus Nelfinavir plus efavirenz.