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HIV Drug ResistanceHIV Drug Resistance
          
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Declining for 18 months
Oct 10, 2000

Dear Doctor Holodniy, Thank you for taking the time to answer my question. I have been poz now for 4 years and 5 months. Currently on a regime of Ziagen, Combivir, and Sustiva. My viral load has not been undetectable for 18 months now. My cd4's were ok until last months labs when they fell over a hundred. This is a significant drop for my HIV history. Anyway my Doctor said to take a two week "holiday" so they could do a Genotype. He said the test would have to go to Europe. People in my support group said to get a second opinion. I went to an Infectious Disease Specialist who immediately did a Genotype and lumbar puncture. He called me on the phone to say that there are some mutations. Is it neccessary to take a "holiday" before Genotype if there is a detectable viral load ? Also is it now neccessary to have a Phenotype ? Again thank you.

Response from Dr. Holodniy

You DO NOT want to take a drug holiday before you do resistance testing. You want to be on your current drug regimen to see what mutations are present. If you take a drug holiday, the virus will revert back to wild type in the absence of drug pressure and the resistance test will not be useful. You don't have to get a phenotype in addition to a genotype. It partly depends on what your doctor is comfortable with interpreting. Some people like phenotyping better because it reflects the growth of virus in the presence of drugs, compared to genotyping which looks at mutations and requires further interpretation to determine sensitivity or resistance.

MH


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