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Treatment Options with TAMS

Oct 1, 2011

I am currently not on treatment and have a stable CD4 count of 800 30% with a VL stable at 5000. I seroconverted about 6 years ago and my doctor is suggesting that i should start treatment. When i first tested postive a resistance test showed M41L and T215 mutations. I recently had another test which showed no mutations. My doctor explained that this is common as the virus can mutate to a stronger wild type virus and compete with the orignal weaker version. Is this correct? He did state that the mutations would still be archived. If this is the case what would my treatment options. My dr is implying i can use standard first line. Is this true?

Response from Dr. Young

Hello and thanks for posting.

It's good that your doctor tested for initial drug resistance; s/he did identify important resistance mutations that confer resistance to some nuke medications. In order to answer your question accurately, I'd need to know the specific mutation at codon 215. However, if one enters your virus' resistance mutations into the free Stanford HIV Resistance Database (and I encourage you to do so), you can get a prediction of which medications your virus might be resistant to.

The issue is that once you have resistant HIV, it lurks in the cells that it infected- perhaps years ago. This is the archived virus that your doctor refers to. This resistant virus, though maybe not detected in the current "no mutation" test, would readily reemerge when a non-potent treatment was started.

However, I disagree with the generalized notion that you don't need to worry about this resistance; rather, I'd try to estimate what the most potent regimen is (based on the worst-case resistance test interpretation), and if otherwise appropriate use that regimen. In such cases, if there's any question of the overall potency of the nukes (NRTIs), I'd tend to avoid the 3rd agents with low genetic barriers, such as NNRTIs or integrase inhibitors in favor of boosted protease inhibitors. In the end, this decision could lead to a standard first-line regimen; it could lead to an alternate.

I hope that helps, BY

HAART sensitivity

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