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Future and med choices

Jul 16, 2007

Hi Doctor My Background: just started treatment (Oct 06)nadir 237-22%,VL 37K follow up test was 526,23% I think my doc should have repeated test before recommending treatment, but I digress.

-Atripla (Current#'s687,32% VL UDw/in first 6 weeks. Given that history,How likely is it that I can keep my vl <50 for decades.?My MD didn't do a resistance test until I was at about 1200, no resistance shown I read so much about the threat of resistance, yet it seems to contradict the optimism on this site. I'm thankful for the optimism, don't get me wrong. But with so many mutations constantly occurring w/in the body, how can it be so likely that people can make a regimen last a lifetime? Thanks for your time

Response from Dr. Wohl

I do not know that any current regimen can "last a lifetime". Certainly, they can be effective at suppressing HIV replication for years. Why do they fail, you can count the ways. Anyway, the idea is that if you reduce the number of replications then the risk of resistance falls. Mutations develop when virus is making copies of itself. Bring that to a stand still and a rare chance mutation becomes infinitely rarer.

You make a good point about transmitted resistance (drug resistance virus that was transmitted during infection). About 15% of people will have a major mutation against an HIV med prior to starting HIV therapy - typically a mutation against the NNRTIs (efavirenz, nevirapine). Thus, 85% will not. Still, a resistance test should be done prior to starting meds. The good news is that if you had pre-existing resistance, it likely would have been seen with the on-treatment genotype.


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