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just diagnosed with resistant virus!!
Feb 22, 2004

Dear Dr.

I was infected this past may. My last numbers were VL 160K and CD4 350. My genotype had the following resistance mutations: Protease: L10V, K20R, M36I, L63P, A71V, V82A, L90M; Reverse Transcriptase: V118I. I am really concerned because by what I have read on the net it seems that my virus is resistant to all PIs!! 1) Is that so? What about new PIs like atazanavir? What about NRTIs and NNRTIs? 2) Judging by my blood numbers and genotype, should I delay starting therapy as much as possible since I do not seem to have many options left or should I start asap to try and get it under control? 3) I had heard that mutated virus was less virulent but I was infected 7 months ago and already my numbers are worrying!! 4) I have heard Drs. say that now adays you can expect to live normal life spans with HIV infection... does that apply to my case too or would it depend more on scientific progress and new drugs? It was hard enough to know that i was HIV +, but when I had finally dealt with it I am told that my virus is very resistant to a lot of meds!! 5) Will I ever get to undetectable? I am soooo scared!

Thank you... I am aware that my question is long and probably complicated...

Grateful spaniard.

Response from Dr. Pierone

You have a challenging situation, but certainly manageable. First, it appears that the virus you acquired will be difficult to treat with currently available protease inhibitors. This simply means that when it comes time to start therapy it should be with a NNRTI-based regimen. At that time, you had better be ready and committed to full adherence because if you develop resistance you will have fewer treatment options than the average person beginning treatment with HIV. More drugs are in the pipelines directed at new viral targets, but you will want your first regimen to last many years. Along those lines, our team has many patients that are still on their first NNRTI-based regimen for 5 plus years with no signs of resistance and doing well.

There is a consensus starting treatment window that is between 200 and 350 CD4 cells. In your case, it seems prudent to start therapy later in that window rather than sooner because of the existing resistance. Long-term survival and normal life-span is possible in your situation, but will be dependant on meticulous attention to health and medication adherence when treatment is commenced. Let us know how your next set of labs comes out and best of luck!



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