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Resistance to NNRTI and Sensitivity
Mar 14, 2010

Hello, I have been HIV+ for seven years without ARVs. For most of the time my viral load had stayed below 50,000 and CD4 about 500. This summer, i became ill with chigella, c-diff, and pneumonia and my CD4 plummted to 220. Then when back to around 400. Now, my viral load is 70,000 with CD4 of 330 and I just tested positive for syphillis, so my doctor is recommending meds and pencillin. I'd like to start asap, but I'm concerned because my PhenoSense GT report indicates that I'm resistant to the 3 NNRTIs, and sensitive to Etravirine. I'm sensitive to 12 PI, and also 6 NRTI. My Virus Replication Capacity is 123%. My doc says that just because I'm resistant to the class of NNRTI, isn't bad - there are plenty of options. But does that mean that I'll need to try some of the older more difficult drugs to tolerate? And what does the sensitivity and Virus Replication Capacity mean? I'm very worried about this and won't be seeing a doctor again til later this week. Many thanks for your time and input.

Response from Dr. McGowan

Thanks for your question.

Yes, you do have good options for treatment. There are excellent PI therapies that are new and do not share some of the side effects of the older combos. 2 of the most successful and best tolerated are Atazanavir (Reyataz) and Darunavir (Prezista), both of which would need to be combined with ritonavir (Norvir).

Resistance means that you have been infected with a virus that had mutated to be able to grow in the prescence of one or more of the drugs we use to fight HIV. The person who gave you the virus may have been taking that medicine. The Replicative Capacity (RC) is a test that was developed by one of the testing labs to get a sense of how well the virus can grow and infect new CD4 cells. Sometimes when the virus picks up mutations against medications it can survive under treatment but may be slowed down in its growth because of the mutation. It is like the soldiers who need to wear body armor and gas masks when they go into battle, it helps them survive but can slow them up. A RC of less than 100% means the virus growth is less than a non-mutant strain. More than 100% means it may be more efficient than the non-mutant strain. We do not know how relavent the results of this test may be so I wouldn't worry too much that it is high. This will not affact the response to treatment.

Best, Joe



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