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Atripla working despite resistance
Nov 18, 2007

In April 2006 I was diagnosed HIV+. I tested negative in July 2005 and strongly believe I was infected in the Nov-Dec of that year. In May 2006, I took a phenotype resistance test indicating I had pre-existing resistance to all NNRTI's, most NRTI's and several PI's not good news. It was just as upsetting to hear this resistance news as it was to learn I was infected. In November 2006, I requested a repeat of the phenotype test and also a genotype test. Neither showed evidence of resistance.

I continued to get labs every 3 months, with my CD4 count falling between 450 and 650 and viral load around 40,000 for the next year, although my CD4% decreased by 3-4 percent every 3 months. In June 2007 my CD4% was 450. my CD4% had fallen to 17.5, and my viral load had jumped to >100,000 (exceeding the sensitivity of the test given).

I asked my doctor to let me try Atripla. My argument was that I had conflicting resistance tests and although the later test may be the result of the resistant virus being overtaken by wild, that usually doesn't happen so quickly in cases of transmitted resistance. Also, the first test showed me already resistant to all three components of Atripla so if it was accurate, there would be little negative pressure on more mutations. I would also do viral load testing at 6 weeks, then every 4 weeks so if Atripla wasn't going to work for me, we'd be able to act quickly to avoid any potential additional mutations.

My results are: Initial CD4 450, CD4% 17.5, VL > 100,000 6 week CD4 700, CD4% 20, VL 1,750 10 week VL 80 14 week VL undetectable.

I had a flu shot two weeks ago, so instead of getting another VL at 18 weeks, I've put it off until 20 so I won't lose any sleep over any potential immunization related blip.

I write this not to boast about my wonderful results, but to let others know that while resistance testing is definitely a powerful tool for treatment guidance, they don't always tell the whole picture. I see it like a navigation system in a car: they are extremely helpful in pointing you in the right direction most of the time, but sometimes they tell you to turn into a lake or to go the wrong way on a freeway.

It may have been a risky strategy, but I'm glad that it so far has worked out. With the response I've had so far, do you think it's reasonable to think that Atripla may prove durable for me?

Response from Dr. Pierone

Hello, and thanks for posting.

Congratulations for sticking to your guns and trying this approach in spite of the conventional wisdom which would have had you taking a much more complicated regimen. Anecdotal observations like this one are how we learn to consider new approaches for managing HIV infection.

That said, you are early in the course of treatment and it is possible that the (presumably) archived multi-drug resistant virus strain of virus might re-emerge over time. Even if this happens though, I don't think you have hurt yourself and other treatment options are certainly available.

Thanks for sharing your story and keep up informed about your progress from time to time.



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