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Tropism and treatment start

Dec 16, 2012

Dr. Holodiny,

I seroconverted around June 2012, tested positive October 2012 and got my baseline labs November 2012 with CD4 486 & 29% and viral load of 26,928. I'm 23 years old, feeling healthy and so far basically asymptomatic. I also got a genotype which showed no drug resistance and a tropism assay that showed mixed tropism.

My doctor told me two things that I found confusing, one that complera wouldn't be advisable since my viral load is above 25,000 copies(I have read it is inadvisable when above 100,000). Also, that mixed-tropic virus was the most common for primary infected, treatment naive patients. I had thought(and was hoping) that my virus would be ccr5 tropic this early in its course and had read that ccr5 tropic virus is the most common in this category.

I was wondering if you could clear up some of this confusion and recommend if treatment is more urgent because of my mixed tropism virus and if complera is an option.


Response from Dr. Holodniy

You are correct. The current label indicates that in the clinical trials that studied Complera, there were more virologic failures in those people with a baseline viral load > 100,000 copeis/ml compared to those with viral loads < 100,000/mL. So you are right in the target viral load range where this combination should work. Most "HIV drug naive" people, and those with higher CD4 counts (like yours) when tested, did have R5 tropic virus only. However, given that your infection is new, it is certainly conceivable that the strain that was transmitted could be a mixed tropic virus from a person in a different stage of HIV infection.

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Truvada + Raltegravir Resistance

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