Managing HIV/AIDS Therapy in Treatment-Experienced Patients When do you use a non-nucleoside regimen?
	Enlarged Version of Graphics Below	Dr. Kwakwa (OC): I personally tend to use a non-nucleoside-based regimen as the second line of therapy, rather than first-line, and the reason I do that is twofold. Number one, I have a better sense of what the patient's adherence is going to be, that it is not based on an initial perception of the patient, and number two, the phenomenon of non-nucleoside hypersusceptibility does translate to some clinical benefit, at least in the short-term, and so, I believe that we get a little bit more out of the non-nucleosides as the second line of therapy, rather than as a first-line. Dr. Wohlfeiler (OC): ...actually that is something that I often will do is hold the nonnucleosides in reserve a little bit to use them second or third regimen down the line because I think you get more bang for your buck with them. Dr. Bellos (OC): With a non-nucleoside-based regimen, you have a little bit of a different agenda, simply because of the fact that a single mutation can cause you to lose the entire class, or the efficacy of the entire class, and so, you don't have as much room with the non-nucleoside regimens as you do, for example, with the PI or the nucleoside-based regimens. As these mutations develop both in the PI and in the nucleosides, what happens is that you gradually begin to lose activity of the drug, whereas with the non-nucleosides, once you develop the signature mutation, the entire class is gone. It's not a gradual decrease in loss of efficacy of the drug, whereas that is what you could see with the protease inhibitors.
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