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Raltegravir Resistance

May 27, 2012

Hi Doctor Mark. My story is this. I get infected with a high resistance virus, my first medications were truvada and kaletra, unfortunately I developed resistance to both and my doctor decided to add raltegravir to my meds one year ago. The trouble is that my viral load since january is going up and apparently raltegravir stopped working. My doctor is deciding to prescribe me etravirine, darunavir and raltegravir, but I want to receive full active three medications. My other two options are maraviroc and enfuvirtide that are not easy to find because I am with a government assurance. I have been calling to labs of here if some of them have a hiv genotype that includes the mutations for raltegravir, so in that way we can see if raltegravir can still work. Unfortunately there are no labs that evaluate raltegravir resistance in Mexico, I was thinking in find someone in the US. I know some labs of here send test samples to labs in the US for hiv genotype, so maybe I could contact a lab in the US and a lab here and try to do the same. THANKS A LOT!

Response from Dr. Holodniy

Well the devil is in the details, as to exactly what mutations are present in the reverse transcriptase, protease and integrase enzyme sequences to know exactly how to proceed. The regimen your doctor is considering would not be a bad approach. But, you need to know whether the mutations present affect etravirine and darunavir, and I agree you need to know whether the virus has developed resistance to raltegravir or not. I would want to know that before stopping it. Maraviroc would require a tropism assay to determine whether your virus is R5, X4 or mixed, with only an R5 virus positive result indicating that maraviroc would work. That test is very expensive and is not included in standard resistance tests.

big drop in cd4 and cd4 percentage
cd4 counts

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