I have researched this issue and still do not completely understand it. In my case I became aware of my positive status in Dec of 2005 probably infected in late 2004. I am in my fifties and in excellent health, normal CBC and chemistries. CD4 count on three tests are 400-554. 40% each time. First VL was 128 then 278, last was 1600. HIV experts say even though I don't need meds now I need resistance testing now. Why? It seems it would only add to anxiety to know I might have a resistant strain and med options when I eventually need them would be limited. So am I actually at a disadvantage if my viral load were to stay below 1000 and I couldn't have the testing done? Why not simply wait till I reach that magic CD4 number of 350 and get tested then.

Also in your opinion and experience, with my numbers how many years would you estimate I have before needing meds?

If you were a patient in my care I would advise getting the resistance test now, if possible, i.e. if your viral load on that day were 1,000 or greater and the lab was able to sequence your virus. If the lab were not able to do so, I would suggest that we continue to request the test, given the current range of your viral load (i.e. as low as 128 and 278, and as high as 1600), so that we might be able to sequence the virus and obtain the genotype once in your first year of infection.

I would do so to help me guide my advice to you regarding the choice of ART, and more specifically to avoid prescribing a drug to which your virus was resistant and unlikely to be effective.

In the US, roughly 10% of recently infected patients have one or more drug resistant mutations. Hence the chances are good that you don't have one. Even if you do have one, the chances are excellent that you will have a positive response to the first line treatment that we would choose together - so there is no reason for the outcome, one way or the other, to be a source of greater anxiety for you.

As your doctor, one part of my commitment to you would be to not be hostage to your anxieties, if they were misplaced and not of consequence in the practical issues that should guide your care.

While having a viral load below 1,000 is an inconvenience, since it would prevent getting the result of a resistance test, its not a disadvantage to you, its a good thing. If we were unable to get a resistance test ever, and your CD4 cell count fell to below 350 copies/ml, I would choose your regimen without that information, with every expectation that your chances of a good response are excellent - again, no particular cause for anxiety.

I urge you to talk to your doctor about your concerns and this response.