I discussed your suggestion to get resistance testing now, before meds. My HIV MD and her PA in a NY state university setting both say they do not test before meds unless the patient is pregnant or recently seroconverted. She stated that testing now without the pressure of meds would mean the test would likely only show the wild type virus not any resistant strains. She claims that the current guidlines do not recomment testing now. She said she would do it if I insisted if my VL was greater than 1000. I'm not sure what to do at this point with such opposing views

Your doctor and her PA are citing outdated recommendations; both the 2006 HHS Guidelines and the most recent IAS Guidelines on Resistance recommend baseline resistance testing prior to treatment initiation in the United States for ALL HIV+ patients, not just those with recent seroconversion.

I advise you to insist on the performance of a genotype test before starting treatment, and to discuss this advice with your doctor and her PA.

In a US national CDC study of recently and chronically infected patients, 12% of recently infected patients and 9% of chronically infected patients had a mutation to at least one drug, and 2% had resistance to 2 or more drugs. There are similar data for patients in Western Europe. Hence your doctor is correct that the chances are good - 90% - that you have a wild type virus, and that all ART options are available to you. However, a 10% chance of resistance to one drug is a significant one, and both you and they would benefit from identifying such a mutation, if it exists, and basing your treatment on that information, as well as on other factors.

The links to the two guidelines mentioned above are noted below.