Hello and thank you for this site. I'm a treatment naive patient, i've been hiv positive for nearly 6 years, my cd4 have been slowly declining from 900 to currently CD4 320 / VL 10 000, I guess it's time to start meds. My doc suggests reyataz/truvada/norvir or sustiva/truvada. I've no idea which is the best regime but I guess both are OK ? Anyway, I read It's standard to have a resistance test before starting treatment, I spoke with my doctor about it and he said it's not necessary, we can change the treatment if anything gets wrong, I insisted about having this test done and he got a bit upset about it. My question is : is it OK to start treatment without a resistance test ? I live in Germany and there is no problems of any kind with insurances. Should I look for a new doc ? Thanks, Eric

Guten tag and thanks for your post from Germany.

As I understand them, European (and British) HIV treatment guidelines recommend HIV resistance testing for all persons (just like our US guidelines).

Indeed, the roughly 10-15% transmitted drug resistance frequency is similar on both continents.

If I were your doctor (or you), I'd want to know if I was among the 1 in ~8 persons who acquire drug resistance before committing to a treatment regimen. In the absence of testing, given that non-nuke (ie., Sustiva) resistance tends to be more common, I'd avoid starting this way and utilize a boosted PI-based regimen.

Hope this helps, BY