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Follow-up to starting treatment
Feb 13, 2010

I was reading a Q&A about starting meds. You said liver, kidneys, heart, etc should be checked. I know liver and kidneys can be checked via labs. How should heart be checked? Just listening to the heart, or more sophisticated heart tests?? Cholesterol tests can only tell ya so much about how good the heart is.

Also, I've been hearing so many talk about this K103N mutation. I was just going through my labs and noticed I have the mutation. When I google it, it talks a lot about Sustiva. I knew I was resistant to that. I'm told I'm good to go with all other meds. Is there something more about the K103N mutation to be concerned about?

Thank you

Response from Dr. Young

Hi again. Thanks for your follow up.

A good question about monitoring. Too often, IMHO, doctors and patients think that the only element to medical care is a prescription or lab test. It's my belief that there's a lot of medical care that happens before, and after these decisions. For example, with regard to heart disease- the first element is a clinical risk assessment: do you have heart disease or abnormal heart rhythm, or heart disease risks (hypertension, diabetes, smoking, family history, elevated lipids, dietary characteristics, lack of exercise)? Second, physical examination by the doctor can sometimes reveal evidence of heart problems. Lastly, certain diagnostic tests can be run- basic blood chemistry, fasting lipids (cholesterol, triglycerides), cardiac C-reactive protein or electrocardiogram (EKG). Taken together, all of these data points would go into an assessment of heart disease (and heart disease risks). A similar kind of assessment can done for any health related situation.

As for the K103N mutation; you're correct that this means that you have acquired a drug-resistant strain of HIV- one that is resistant to the first-gen non-nukes, like efavirenz (Sustiva, part of Atripla) and nevirapine (Viramune). The presence of K103N also raises the possibility that there could be other archived resistance mutations that are not detected by the genotype. I take a very careful look at the genotype report to see to what extent other minor PI, NRTI or NNRTI mutations are present; once treatment is started, I'll tend to monitor viral load responses carefully. Any slower response to treatment raises the possibility of the emergence of previously hidden (or archived) resistance.

I hope this is helpful. Be well, BY



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