Ols tell me if a patient has received art in the past and has stopped it how does one approach. are there some guidelines. this will be a long ans as this will involve various factors. sachin d

If a patient has received and stopped the ART, resistance will depend on what was the HIV viral load at the time of stopping and whether the drugs were stopped abruptly or gradually. If the viral load was undetectable and the NRTI were stopped after a week or 2 after stopping the NNRTI then chances of resistance are low. However if the virus was not completely suppressed and the drugs were stopped abruptly then most likely the child will have resistance to these drugs. Thus, one may consider other drugs for starting treatment. For e.g. if the child was on NNRTI, then PI should be substituted and if he was on PI then NNRTI should be substituted. Regarding the NRTI, if he was on AZT, then D4T may be considered and vise versa. Instead of 3TC, ddI or ABC may be considered.