I tested positive in Oct 1995. I was very strict about following my medication regimen for 4 1/2 years. After suffering the kidney stones twice and the constant diahrea, I eventually stopped taking my meds. I have never had an OI, but this past spring began to feel a little less than energetic. I got some bloodwork done and my VL was 13,000 and Cd4 was 370. My doctor advised that recent studies indicated that I could refrain from restarting meds at that point. This past August, I had a fever and rash. My labs now are Cd4 of 264 and VL of 80,000...a week later they were at 347 and 20,000. I have decided to restart medications. Would you advise getting a genotype first to determine which meds I should begin taking?

Thanks

Chris

Excellent question. Resistance testing is best performed on blood samples when you are on treatment, because resistance is more likely with ongoing replication in the presence of drug pressure. You don't indicate what your baseline viral load was prior to ever starting treatment, and whether you had undetectable viral load levels while on treatment. If this was the case and you stopped all drugs together, then the likelihood of resistance is extremely low in your case. If however, when you stopped meds you had detectable viral loads, resistance is more likely. However being off meds for a significant period of time will allow most detectable resistance to disappear from the blood. It would only be seen again when HIV drugs are restarted.