Is genotype a good idea?
May 24, 2001
I have decided,with my id doc,to stop haart and give my body a rest from sustiva/abc/epivir.I will begin by not taking the sustiva tonite and continue with abc/epivir for 6 days.If I have always had a unded vl on meds,ie no probable resistance,would you agree that a genotype, done typically as soon as vl rebounds(3weeks)is not indicated or might it be a good idea since I would only have this one opportunity.?I have recd 2 diff opinions from id docs and would apprec your input.Most sincerely,Luke
Response from Dr. Young
thanks for your question.
Sounds like you've had good counsel about how to stop your current regimen. This is based on the idea that the half-life of efavirenz is much longer that that for either abacavir or lamivudine. Stopping efavirenz first allows all three drugs to be removed from your body at approximately the same time, minimizing the risk of mono- or dual-drug treatment and the risk of drug resistance.
You ask a good question, one that doesnt have a strict single answer. Since you have had undetectable viral loads, the likelihood of having resistance mutations in your virus is very, very low. One could argue that there would be little value in obtaining a genotype.
Alternatively, you could argue that if you didn't have a baseline genotype obtained, that following treatment discontinuation, this would be a reasonable opportunity to assess if there is any evidence of resistance now.
In practice, I usually get genotypes at time of treatment failure (not your situation) and prior to the initiation of a new (or resumption, I would suppose) regimen.
Hope this helps, BY
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