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HIV Drug ResistanceHIV Drug Resistance
           
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Not enough virus to determine resistance
Mar 23, 2002

My GP recently decided to run a resistance test on me in that I wanted to get off of Zerit due to weight loss in arms and legs and mild neuroathy. The test came back saying that there was not enough HIV in my system to test for resistance. I tested positive 2 years ago, have no idea how long I had been infected. Am now almost 70 so suspect it was at least 10 years ago. My viral load went from 27000 to undectible in just a few months. (<50) and my cd4 from 257 to 639 at the last testing. Have been on Zerit, Epivir and Sustiva from the start. Was thinking of changing the Zerit to AZT. My doc thinks the resistance results es extremely good, but says he can't say for sure. What do you think... and is this to be expected if <50. Thanks....

Response from Dr. Little

It is completely predictable that for someone with a viral load less than about 500-1000 copies/ml the resistance test will not be successful - this means that you do not have enough virus in your blood stream to even evaluate the presence or absence of resistance. In this case, changes in therapy are made on the basis of past treatment history and toxicities rather than evidence of virologic failure.

Many people with weight loss in their extremeties are now trying to discontinue d4T in the hopes that this will improve their fat loss, however, we do not yet know if this will reverse the process. In general, I do not like switching from d4T to AZT if there is any concern for d4T resistance since these drugs do have a partially overlapping resistance profile. However, in your case, it appears that you may have no resistance - so this is not unreasonable. I would however also discuss tenofovir as an alternative to d4T or trizivir with sustiva. There are several possible choices - and none is right or wrong - I would discuss the pros and cons with your doctor.


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