Question

Can I get resistance from an ARV overdose?

2 May 2009. Related: All topics, Changing treatment, Resistance, Side effects.

Hi there.

First of all thanks for an excellent resource.

The information you provide, allows people to frame their diagnosis in a more positive (pun intended) context and takes a lot of the anxiety away.

Okay, last August I was not at all coping with my diagnosis and the fact that I had a mutation in my HIV (T215S) or the fact that my CD4 was fairly low (190), so I did something silly. I overdosed on a weeks meds, which at the time were Combivir (AZT+3TC), tenofovir and Sustiva (efavirenz).

The effect of necking seven Sustiva tablets was not pleasant, with a weekend of nightmarish thoughts and visions – horrible. After 5 or 6 days I was put on my current combo replacing Sustiva with boosted Reyataz (atazanavir+ritonavir).

At the time of my overdose I had a viral load of 14,000, which reduced to undetectable after 3 or 4 weeks (overdose, + 5 days no meds + 2-3 weeks current combo). This combo has worked marvelously as my viral load is still undetectable. However, I still worry about the virologic consequences of what I did.

My mental health is good these days, apart from this niggling anxiety. So, what is the liklihood that I developed mutations against the nukes in my combo (Combivir, tenofovir) and Sustiva (the K103N mutation)?

I would like to go back to using sustiva at some point.

Thanks and keep up the BRILLIANT work you guys do. You make a difference!

Answer

Answer: Simon Collins

Thanks for your question and for allowing to post the answer online so other people can benefit from the information.

I’m sorry to hear that you were having such a difficult time last year which brings up several important points.

The first is that your feelings of desperation, and the decision to take an overdose, may have been related to the Sustiva (efavirenz) in your combination. Mood changes are associated with this drug and in a small number of people this has been linked with suicidal thoughts and actions.

It is difficult to separate your own feelings and the impact efavirenz had, but this may be a good reason to be cautious of using efavirenz in the future.

Your doctor should have highlighted this as a possibility to explain what happened, and why you had such a difficult time.

Secondly, increasing the dose of any HIV drug will not increase any risk of resistance. If anything, it may have made the combination more powerful for that week and made resistance much less likely. The risk of resistance some when drug levels become to low, often because of missing of being late with ARV doses.

Your CD4 count of 190 was actually pretty strong and just below the level that used to be recommended for starting treatment. Over a third of people in the UK are diagnosed after their CD4 count has dropped below 200, and while this is not ideal, most people do very well once they start treatment.

Also, the T215S mutation, while showing a possible reduced sensitivity to AZT, wouldn’t really limit your treatment options, especially as AZT isn’t widely used now in first-line therapy.

A technical reference to this is included below in case this is of interest.

It is great that you are feeling better now and that your new combination is working well.

Thanks also for the nice feedback, which is always appreciated.

From HIV inSite:

“T215S/C/D are transitional mutations between wild-type and Y or F that do not cause reduced drug susceptibility but rather indicate the presence of previous selective drug pressure. They are also referred to as T215 revertants because they are commonly observed in persons who once had viruses containing T215Y/F but who discontinued therapy and in persons who have been infected with a drug-resistant virus.”