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Starting meds?
Apr 30, 2010

Good morning doctors, and thanks for your service.

I'm a 33 y.o. guy from Rome. These are the results of my analysis in this 2 years (CD4, % and viremia):

oct 2007: negative aug 2008: 395 32% 109.000 nov 2008: 464 26% 70.000 jan 2009: 402 25% 75.000 apr 2009: 524 29% 89.000 jul 2009: 723 34% 113.000 oct 2009: 675 30% 892.000 jan 2010: 529 32% 117.000 20mar 10: 347 26% --

The last analysis was made in another hospital (a metabholic clinic) and today I did it in my usual clinic. My doctor ordered a resistence test cause in October I had a really high viremia, and she thinks I could have had a new infection (in the former I had a wild type virus and she thought for me for Atripla like meds for the future).

Now I have an appointment with my doctor the 24th of April (cause she said that the genotypic resistence test needs 3 weeks for being done).

What do you suggest me? Should I wait a month and start the therapy after the new resistence test or starting earlier but with which meds? Is it possible that I had a new infection (I had a big decline in cd4)?

Thanks and arrivederci

Response from Dr. McGowan

Thanks for your question.

I would recommend treatment, but no need to rush until the resistance results are in. There does appear to have been a "shift" in that your viral load has gone up and the CD4 declined more rapidly in the most recent tests. This could be caused by a "superinfection" which may or may not carry drug resistance with it. It may also be caused by a shift in tropism of your virus (tropism is the term used to decribe which of 2 pathways the virus uses to enter the CD4 cell. Usually after infection the virus uses one pathway called CCR5, but for many people over time the virus can shift and enter the cell through a second pathway called CXCR4...if that happens the viral load often goes up and the CD4 drops more quickly). Either way you should start treatment which can be guided by the genotype test.

Good luck to you,

Joe



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