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Virus too weak for a genotype test?

Jun 6, 2003

Doctor combivir/vired/virumue. I have been on combivir for over 7 years, 2 years on viramune and 1 year on viread I think.

I had taken PIs before but I switched to other classes because of lipids etc, no vl failure there.

My VL 2 weeks ago was 670, 2 weeks later(today) is 1200, double. The doctor order and genotype test and the lab sent back a report saying that they virus was too weak to test, something like that. The doctor drew more blood today for more vl test, for genotype again and phenotype.

He keeps saying that vl fluxuates and I should not worry. I kee p saying to him that the vl should be under 50 copies as it was for many years, very frustrating. He says that he wants to see the resistance test before he changes the meds.The tests will come back in 3 weeks

Is my doctor right about all these test or he should go ahead and change meds?

Is it 3 weeks a long time to sit and wait? Why the lab cant get the genotype test done? What would you do in my case?


Response from Dr. Young

Thanks for your question.

Yes, viral loads do fluctuate quite a bit (as much as 5-fold from day to day in the untreated person). I'd agree with your doctor that trying to assess what's going on with your virus and the possibility of drug resistance is a sound idea.

Because diagnostic labs have difficulty getting sufficient virus to detect drug resistance, they need a certain viral load level present in the blood sample to tell us about resistance. This level varies from lab to lab-- typically viral loads of 1000 copies/ml. It is relevant to know that diagnostic labs are working to lower this level. Virologic labs, for example now are able to detect genotype/phenotype on blood samples with viral loads of 400 copies, and if specially requested, can attempt to get information about viral samples with even lower levels.

Having the resistance information in hand will allow you and your doctor to make much more educated decisions about your best next treatment options, and may very well influence treatment decisions far in the future. So, I'd try again to get the resistance test.

In the end, if there is a considerable need to treat- then switching without the data would be ok. Alternatively, some have stopped medications while waiting for the information (in order to avoid getting additional resistance mutations and cross resistance). These are decisions that should be made on the basis of your particular clinical situation and I'd work with your doctor to find the best solution.

Good luck. BY

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