Dear Dr. Bob,

I wrote to you on 2nd Nov , the subject (loose stools , not on meds). I wish to thank you for your kind and professional advice.

I now have another query relating to my `resistant` virus. Thank you for pointing out that even a recently infected person can be infected with a virus that is resistant to most meds. , this appears to be my case.

While i have faith and confidence in my doctor, i am very concerned. He was very surprised to see what the results of my resistance test showed, my virus is resistant to almost all meds. For him , i am a "rare" case. On the other hand , he`s happy with my numbers and says i should not be worried, as i may not need meds for a long time. Things would be difficult if i needed them now.

As i live in France , i refer to this site alot for help and support in english , my native language! I placed a post concerning "My Resistant Virus" under `living with HIV` in the hope of some useful information.

Here are some responses i recieved : "HIV/AIDS meds resistance is due to the progression of the disease and the disease against med induction.. either you or your doc is a crackpot, you decide " .

Nice advice.... i can assure i`m not a crackpot and don`t believe my doc is either.

"Once infected that "highly resistant strain" will go to work and show damage twice the normal rate. Resistance will tear yout Tcells down rapidly and will hike your VL up in a heartbeat. Resistance is the mutation that allows the virus to "adapt" to the meds and work as if the meds are n`t even there, often with the side affects of the meds".

As upsetting as it is to read this kind of stuff, i would rather know the truth.

Does a resistant virus mean that it will be stronger and work quicker in killing my Tcells and bringing up VL??

My VL is nice and low at the moment 1,400.

Do numbers for CD4 and VL stabilise at this stage , almost one year infected , if so, is there a time span?

If the day comes , do you believe that my doctor will find a way to treat me effectively? Maybe a mixture of drugs?

I spent months coming terms with being HIV, then everyone says.. `it`s not what it was , with meds theses days it`s very treatable`, so hearing about my resistance test was a big disappointment and deception!

I would really Appreciate your feedback on this , please let me know if you require further information!

Regards,

Confused.

P.S. This site is great... a real life line!!!

Hi Confused,

Welcome back to the forum. I'm sure the folks who provided the advice and comments meant well. However, the information they provided and their assessment of your situation is not accurate. Your physician is correct: It is relatively uncommon for someone recently infected to be resistant to "almost all meds." With more drugs available and HIVers living longer, "healthier" lives, it is not surprising that we are seeing a gradual increase in the transmission of drug-resistant virus. Certainly, acquiring a drug-resistant strain of HIV limits your treatment options.

Addressing your specific questions:

1. Drug-resistant HIV strains are not necessarily "stronger" or more capable of destroying CD4 T cells. In fact, there is often a "cost" to the virus when it becomes resistant to a drug or multiple drugs. It may have decreased "fitness." The problem is that even with decreased replicative capacity and fitness induced by drug resistance, if you have no (or limited) options for antiretroviral therapy, viral replication progresses unchecked and will over time decimate the immune system.

2. A low HIV plasma viral load is good; an undetectable viral load, even better.

3. Often, the body's immune system and HIV come to an equilibrium as they fight against each other. This is referred to as the "viral set point." It can persist for some time (variable from person to person), but eventually the virus wins out, viral load goes up and CD4 cells decline.

4. Finding an effective antiretroviral combination depends on your resistance profile and also on what drugs are (or will be) available at the time you need to begin treatment. Stay tuned to this site and we'll keep you updated as new and novel therapies become available.

Good luck.

Dr. Bob

Loose stools, not on meds! Nov 2, 2009

Dear Doctor Frascino,

I was infected with HIV in December `08 and diagnosed in March `09. I currently have CD4 of 729, and a VL which has dropped form over 10,000 to 1,400. According to `resistance tests` , i have a virus which is resistant to most meds. but i`m not at a stage where i need meds yet.

My question is , for several months now i have had loose stools, things don`t seem to be as regular as they were before! I don`t have a fantastic diet, however i have n`t changed anything!

Could this be related to my HIV? or some other type of infection? or a cancer ?? i feel embarassed to visit the doctor, but i have made an appointment with one (not the one that treats my HIV). I would prefer not to tell this Doctor about my status. Are they`re any foods or medicine that could help improve the situation? I live in Europe!

Regards

Response from Dr. Frascino

Hi,

That you have contracted a virus that is "resistant to most meds" should be a warning and wakeup call to everyone reading this forum. It is indeed possible to contract a strain of virus that is already resistant to one or even many HIV medications, making treatment much more difficult.

I cannot diagnose the cause of your loose stools over the Internet. Could it be related to HIV? Yes, it's possible. Could it be some other type of infection or condition? Yes, that's possible as well and most likely is the case. Is it cancer? No, that would be highly unlikely.

I'd suggest you have your HIV physician evaluate this problem for you. He could check for both HIV-related as well as the more routine underlying conditions. However, if you do wind up seeing another physician, I'd recommend you disclose your HIV status. It will help him in the evaluation.

Treatment of your condition will depend on the underlying cause of your symptoms.

Dr. Bob