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Tropism test

Feb 28, 2009

Dear Drs.,

I am positive now for almost a year (but not yet on meds). In the past year I have learned a great deal about the disease thanks to fantastic websites like yours! I just had word from my Dr about my latest blood work and it does not look so rosy anymore. CD4 was 410 and CD4/CD8 was 27%. (three monts earlier that was 650 and 30%; six months before that it was 800 CD4). I asked my doctor if perhaps it was useful to do a tropism test (because I am worried about this rapid decline of CD4s and I read on this side that it may be due to the Virus changing receptors). He agreed to do such test (reluctantly, becuase here in The Netherlands it is not standard;; my blood samples are flown to the US to do the test). My question is: if the test proves to be good (meaning my virus still only uses the CCR5 receptor), should I then, as a first line treatment, use meds that only work at that stage (like Maraviroc) as at a later stage (when the virus evolves and uses the other receptor as well)these options might be lost for me.

Kind regards from Thom, Amsterdam, Thye Netherlands

Response from Dr. McGowan

Thom: You ask a very insightful question. It is true that early on in the course of HIV infection, virus that uses the CCR5 co-receptor predominates in most people and that later on that CXCR4-using virus may emerge. Since CCR5 antagonists (like Maraviroc) are only useful when CXCR4 using virus is not present, it would seem appropriate to use these drugs fairly early in the treatment of HIV. However, current guidelines do not recommend the use of maravoric as a "first-line" regimen. There has been one study (Merit-ES) that showed equal efficacy between an efavirenz based regimen and a maraviroc based regimen, however, since there are first line alternatives to efavirenz that do not require a tropism test, the place of maraviroc for initial treatment remains in question. Thanks, Joe


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