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primary infection with two strains
Feb 2, 2005

dear doctor , I am worried. I was infected may 2004 and began sustiva truvada in july.My genotype showed no resistence. Yet as of my last labs my vl was 120 and cd4 1134.I have been 100% adherent.I have never gone undetectable.Is it possible I was coinfected with two strains that were not picked up on the genotype.My doctor said 120 is very suppressed and told me some patients never go undetectable. What could this mean.I am really freaked out about having a second mutated strain in my body as if one wasn't bad enough.Please repond.By the way my labs have been vl 70, vl 126 vl 120. please respond thankyou.

Response from Dr. Pierone

Your labs show that viral replication is very low, but still barely detectable. Sometimes it takes 6 to 9 months for viral levels to become undetectable, especially if the viral load was high to begin with. So this may yet occur in your case since you are about 7 months into treatment. There is nothing to suggest that you were infected with 2 strains of virus.

I suggest you sit tight and see what the viral levels do over the next several months. If the viral load becomes undetectable then you may choose to continue the present regimen (how long no one knows). But if the viral levels remain of the cusp of detection (or rebounds) over the next several months then you will be at a fork in the road with regard to treatment decisions.

One approach would be to stop therapy and repeat a resistance test during viral rebound. Since early treatment of primary HIV infection does not have proven benefit, this would be a reasonable tactic. For those inclined towards the "hit early, hit hard" school one might consider intensification with a 4 antiretroviral agent or switching the regimen to a different one.

But again, the night is young and you may still see undetectable virus on your current regimen. Let us know how things go. Thanks for posting.



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