Jul 3, 2005
Doctor, 6 years poz, 210 cd4, vl 500k, treatment naive. My doctor prescribes 3TC, Sustiva, Viread. Before taking, I ask for resistance test. He says marginally helpful but OK. Says he'll send to the lab blood collected from me earlier. Results don't come back until yesterday. I started drugs on Sunday. Here's the problem: (Absent lab/office error) I have mutations at 41L, 43Q, 118I, 210W, 211K, 215S, 10I, 33F, 46I, 48V 54T, 71V 74S 82A. Question: Is is possible to have these break through in treatment naive person 6 years after infection? What happened to wild virus theory? Two days of therapy now. Should I keep taking drugs while doctor sorts this out? (Don't want to lose Sustiva) What would you do now if you were me? Thanks.
Response from Dr. Holodniy
That resistance test results indicates evidence of at least AZT and saquinavir resistance. If you have never received treatment, then the only possibilities are recent contact and exposure to someone with resistant virus or lab error. It would be unlikely that all those mutations would have hung around for 6 years after your initial infection. All that said, there are NO fatal mutations present to any of the drugs you just started. It would certainly be worth getting another resistance test this coming week. Your viral load should still be high enough even after having started treatment last week to be able to do the test. I would continue with what you are on currently. If on repeat this is real, it may require an additional agent, to get a multidrug resistant virus with a viral load of 500K to undetectable levels.
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