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RESISTANCE QUESTIONS
Aug 10, 2006

Thanks for your good work in keeping the flow of infmration going and available to us. I am 43 years old and was diagnised 2 months ago. My inital viral load was 335,00 when I found out, 97,000 one week later and 9,700 three weeks later (a couple of weeks ago) My cd4 is around 700. (+,-). My doctor believes (and I agree) taht I recently contracted the virus and was seroconverting at the time of my initial viral load test I also had a resitence test whcih showed sensitivity (no resistence0 to all available drugs and a replication capacity of 12%. (not sure what that means) I am confused about drg resistence. Does the fact that my resistence test resulted in sensitovity to all drugs mean that once on meds if i remain adherent my tretmant will be effiective. If the virus mutuaes on its own and I may be resistant at the time I start meds (hopefully many years from now) what is the prupose of finding out my resistance now? Will I have to have another test before starting meds? Please help me undertsand this difficult piece of the HIV puzzzle.

Response from Dr. Young

Thanks for your post.

Yes, your resistance test implies that the virus that you're infected with is susceptible ("sensitive") to all of the current medications. These tests are probably most accurate in detecting resistance when obtained (like yours) shortly after infection. Testing is now recommended for all treatment naive persons in the US, since anywhere between 10-15% of newly infected patients have some evidence of drug resistance. Resistance isn't selected in patients with wild type virus unless drug therapy is used (an example of Darwinian survival of the fittest).

Curiously, your virus has a very low replication capacity. This test, only available with phenotypic testing, compares how well your virus grows in the test tube compared to a typical HIV (normally 100%). This suggests that the virus isn't very good at reproducing; several studies suggest that this aspect correlates to slower rates of CD4 cell decline and disease progression (a good thing for you).

So, yes, when the time comes to start on medications, it's likely that the selected medications will be fully active against your virus. This isn't a guarantee that the meds will work; of course, adherence to dosing, diet, drug interactions, etc are required for everything to go according to script.

I hope this helps. BY



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