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mutations and resistance
Mar 27, 2006

Dear Dr. Young,

I have written you before regarding other issues and you seem to have a wonderful way of explaining & putting things into perspective. I hope you can do the same in this situation. As mentioned before, I have a wonderful Doc. here in Orlando (Dr. Edwin DeJesus) and he has explained things very well. However, there are always questions that I want to ask after I leave. Dr. DeJesus knew I was very worried that I would have the type of Virus that would not respond to therapy while I waited for the Geno Type test to return. I am not on Meds at this time because my TCells are at 588 and VL at 9000. He believes that this is not the time for meds. The Geno Type came back and indicated that I was sensitive to all Meds. But it showed two mutations. To be honest, I do not remember the type of Mutations. He said that he was not at all worried about these mutations and normally he would not have even mentioned these except I ask him directly about any mutations. When I asked him if I had a Wild Type Virus, he said almost like wild type. I know you have said before that people with Wild Type virus should look forward to a normal life expectancy. Here are my questions and I hope you can answer them because I just appreciate the kindness and knowledge you seem to bring to the table.

1. Do mutations always mean resistance? Does it mean total resistance or resistance to a certain level? Remember the Geno Type said sensitive to all meds, but did show some mutations that my fine Doc said he was not concerned about. 2. Can patients with some resistance, who do not smoke, and have no other co infection, and have the ability to navigate the health care system (Good Ins.) still, look forward to a normal life expectancy with some mutations? My Doc. said yes that I will not die of this.

I hope you can answer. I dont know how you find time to do this with all that you do. God Bless people like you and DeJesus!

Response from Dr. Young

Thanks for your post and kind words.

I'm happy to hear that you've linked up with our good friend (and ace HIV doc), Dr. DeJesus. I agree with the notion that this isn't yet the time to start medications and concur with obtaining drug resistance testing.

What your resistance test appears to indicate is that your virus has some minor genetic changes (mutations)--these minor mutations are not thought to confer any significant resistance (hence, the determination that your virus is susceptible to all drugs). I think of these changes as a fingerprint of your virus that distinguishes it from others, but not one that has implications about drug potency.

To your questions-- no, not all mutations cause drug resistance- indeed, many mutations actually cripple the virus, others are neutral.

Yes, even patients with some degree of drug resistance (with all the qualifiers that you've noted) can indeed, hope to, and expect to live a normal life expectancy.

Lastly, I find the time to answer your posts because I have very understanding business partners and family who put up with my tapping away on my computer, even on family weekends. This work and your commentary is a large part of the emotional currency of the life of a HIV doctor.

Best, BY



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