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VL <50 :alternate tests and choosing HAART regimen
Feb 5, 2004

Dear Dr. Sherer,

It is great to have this forum on such an essential aspect of HIV infection.

I have a problem: not enough detectable virus to do a resistance test...in fact, I often have a VL <50 without being on meds. Even a bDNA has been negative. But Elisa, WB and DNA tests find it.

Any thoughts on other tests that could be done to flush out the VL? Despite a low to nondetectable VL, I have many symptoms that show decline in immune function - such as angular cheilitis, skin rashes, tongue lesions, peripheral neuropathy. CD4 count above 750 with good percent (42).

Your advice on what I could do to take this further and which HAART regimen you would use if you could not do resistance testing (have borderline normal HgB and RBC's, and high insulin and C peptide levels).

Many thanks.

Response from Dr. Sherer

There are resistance tests that are used in clinical research that can detect virus down to 3 copies/ml, including whether or not they have resistance mutations. I would NOT recommend that you seek out such a test, however, because we have too little information on how to interpret resistance mutations in such small quantities of virus.

In general, you would not be considered a candidate for ART on the basis of your CD4 cell count and viral load alone. However, symptomatic HIV is also a reason for starting treatment. Whether the signs and symptoms you describe would qualify for treatment is an issue for your to talk to your doctor about.

There are several options for regimens if you and your physician decise that treatment is indicated. I would refer you to the HHS Guidelines for a list of possibilities (link provided).


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