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HIV Drug ResistanceHIV Drug Resistance
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just diagnosed with resistant virus!!
Mar 4, 2004

ExaDear Dr.

I was infected this past may. My last numbers were VL 160K and CD4 350. My genotype had the following resistance mutations: Protease: L10V, K20R, M36I, L63P, A71V, V82A, L90M; Reverse Transcriptase: V118I. I am really concerned because by what I have read on the net it seems that my virus is resistant to all PIs!! 1) Is that so? What about new PIs like atazanavir? What about NRTIs and NNRTIs? 2) Judging by my blood numbers and genotype, should I delay starting therapy as much as possible since I do not seem to have many options left or should I start asap to try and get it under control? 3) I had heard that mutated virus was less virulent but I was infected 7 months ago and already my numbers are worrying!! 4) I have heard Drs. say that now adays you can expect to live normal life spans with HIV infection... does that apply to my case too or would it depend more on scientific progress and new drugs? It was hard enough to know that i was HIV +, but when I had finally dealt with it I am told that my virus is very resistant to a lot of meds!! 5) Will I ever get to undetectable? I am soooo scared!

Thank you... I am aware that my question is long and probably complicated...

Grateful spaniard.

Response from Dr. Sherer

My first concern is that you might be having this discussion on line only, rather than with a physician with experience in HIV care. I will offer you my opinion in the hopes that you seek medical attention promptly, in order to address these issues.

Your virus is not necessarily resistant to all PIs, but you do have several PI mutations. If you were to use a PI, I would suggest only using a boosted PI, and among the current options, I would advise LPV/r.

However, you do have the option of two NRTIs and an NNRTI, which appears to be a better option for you at present. The choice of individual agents is for you and your doctor to decide.

Exactly when to start is also for you and your doctor to decide. In my practice, I follow the HHS Guidelines, i.e. I start when the CD4 cells are around 350 or lower, and viral load above 50,000-100,000 adds additional weight to the decision to start therapy. Thus I think you should strongly consider starting treatment in consultation with your doctor.

A resistant virus is not necessarily less virulent, so that should not be used as a reason to delay therapy.

You have a good chance of achieving a viral load below 50 copies/ml. In studies of drug-naive patients, its as high as 80%. Your situation is different, as you suggest, because you acquired a drug-resistant virus. Time will show whether you have also acquired other resistance mutations that did not show up on the first genotype test, i.e. that were 'archived'.

Your best option is to see your doctor soon and consider these points. And, if you do start treatment, be sure to take all of the medications as they are prescribed to give yourself the best possible chance of a good response.

epivir and drug resistance tests unreliable for naive docs
can the virus lose resistance?

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