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COnfused re resistance tests - conflicting results
May 24, 2004

I am a little confused and not a little worried. I switched health care providers from Kaiser to San Francisco General Hospital. My new Doc wanted to do a genotype to ascertain resistance and when i returned to his office he said I wasn't resistant to any drugs. I was surprised and told him that my previous Doc at Kaiser had said I was resistant to several meds. So I personally picked up my medical records from Kaiser and delivered to my new Doc and he read them in front of me and said I am resistant to most regimens and I have only one regimen option left. Why the discrepancy re the genotype fperformed and analysed by my new Doc and the info in my Kaiser records. My new Doc has also told me that I need to be on this final regimen for 7 years as no new options will be available for that amount of time (except Fuzeon injections which he is reluctant to recommend uless as a final resort). How likely is it there has been a mistake and how serious is it for me to only have one regimen left open to me? I have been celibate for years so superinfection is not likely. New Doc tells me the reason the genotype was inaccurate was because I have been on a meds holiday for six months and that can affect the outcome of a blood analysis. Is this true? Thanks

Response from Dr. Sherer

Yes, your new physician has given the most likely explanation for the discrepancy between the Kaiser resistance test and the UCSF one, i.e. that you were simply off drugs when you had the UCSF test, and during the time that you were off drug the formerly resistance HIV in your body was overgrown by wild type, which was now allowed to flourish in the absence of drug pressure.

It is common for resistant virus to be overgrown by wild type once drugs are discontinued. Many, perhaps most resistant viruses are 'less fit' than wild type, i.e. their resistance mutation gives them a competitive disadvantage in comparison to wild type.

How serious is your situation? Often in such a setting there is still the opportunity for a prolonged positive response to treatment. The important thing for you to do is to take it seriously, and do your best to take the medication without missing doses in order to give yourself the best possible chance for a durable response.


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