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Resistance Geno test with VL 440?
Oct 12, 1999

Can a genotype resistance test yield useful information if

VL is 440? Reading the answerd questions seems that you need >1000 in order to have enought virus presence to do the GENOTYPE test.

Then why is my New DR.doing this test? I do not have to pay for this test. Had to change ins.co. Oct. 1st

My first visit the DR was talking changing my meds even before he had a look at the VL or my med records (I had them

with me ready to give him) Combivir/Viracept are the meds I am been taking from day 1 June '97 with baseline VL 650K.

Answer:

Response from Dr. Cohen

Well, if your viral load is 440 - that would be one reason why your new MD is thinking of making a change. Because we have learned that if the viral load can grow a little, it might one day grow a lot - and starting doing damage again. And making a change at lower viral loads may be easier in the sense that the HIV at this point may have only created resistance to one of the meds - but the higher the viral load goes, the more of your current meds HIV has learned to "ignore". And if it ignores these meds, it can use those tricks to partially ignore some of the meds you haven't even taken yet - a concept called cross resistance. So making changes at lower viral loads could allow us to have more success with "plan B" since there may be less "cross resistance" to meds you haven't taken yet.

But it would be of use to check your recent viral load history - sometimes people do just "hover" at a low viral load like 440 for months and so there can be less urgency to make a switch... while others can go from below detection, to 440, to 4400, and so on... and seeing which trajectory you are on could give a clue as to how fast to move here.

As for a genotype - you are right that it is difficult for that test to get us a result when the viral load is below 1000 - perhaps your MD has had better luck at the lab that they are using? It would be OK to ask... perhaps there is the assumption that if it was 440 recently, it could be nearer to 1000 now?...

It doesn't sound like you have created that sense of partnership with this new MD yet. Like he was talking new meds before even looking at your records. And it sounds like you need a bit more time to be sure you can trust working with this person - and if your viral load is a low number and staying there for a while - you could have some time to be sure you have that key sense of confidence and trust to consider making changes in this combo. But if the viral load is steadily rising, it may be the sooner the change, the better for you...

good luck.

CC



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