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Strains and Med Resistance
May 29, 2010

This is sort of a strange situation (maybe) but I couldn't really find a definitive answer and wasn't sure which forum was the most appropriate for asking. My partner and I have been together 9 years. He was diagnosed with HIV in December 2007 and started medications in August 2008. I don't remember which ones he's taking, I just know that according to his physcian, he has a resistance to one of the ingredients in Atripla. He told me he was positive in February 2009. Not suprisingly, I tested positive in March 2009. I started Atripla in February, 2010 after my doctor determined I had no drug resistance to any of the medications available. Before you ask, yes, I needed a little therapy after he waited that long to tell me. :-) It is a mute point after the length of time we've been together. We did not have an open relationship and I didn't have sex with anyone else during that time. He claims he has not either and I have no evidence or reason to think he has. So, here are my questions: 1)How is it possible that he can't take Atripla and I can? 2)Is it possible that both of us were infected by different strains before we got together? We tested once shortly after we got together and it was negative so, finding out he was positive was kind of a shock, but now finding out he can't take the same medication I do, I have to wonder if we were both positive before we started dating and hadn't seroconverted yet. Appreciate any insight you have!

Response from Dr. McGowan

Hello Thank you for your thoughtful questions. Even in people who have developed drug resistance, there are a mixture of HIV strains circulating some of which have mutations that confer drug resistance (and that can be picked up by drug resistance testing if those strains are reasonable in terms of numbers)and others that have no evidence of drug resistance. It is a bit of toss up as to which strains get transmitted. Indeed, some studies seem to indicate that srains that do not harbor resistance are more easily transmitted than those that do. But again, we cannot be sure which strain (drug resistant or drug susceptible) is transmitted. Given these facts, it is entirely possible that the strain you may have contracted from your partner was one that had no evidence of drug resistance and therefore your baseline resistance test showed no resistance and the reason you have responded to Atripla. Thanks Joe



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