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HIV Drug ResistanceHIV Drug Resistance
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Aug 12, 2006

Doctor, My VL in Feb was >100,000. Started on Sustiva and Truvada 21 weeks ago. Since then VL reduced to 1600, 300, and then 200 at week 21, when I had flu. Do you think that this is a good reduction as everything I have read indicates I should be undetectable by week 20. Do you think I should consider a change of medication and if so to what? Would my flu have effected the VL levels. Next results due at week 26. BTW been 100% adherant and resistence testing done prior to being perscribed medication. I am in the UK but suspect we have the same medications as the US available. Thank You.

Response from Dr. Sherer

I see no reason to panic or switch medications at this point. People with higher baseline viral loads take longer to fully suppress, even longer than 6 months. Your viral load - "> 100,000" - might have been 200,000, or it might have been 2,000,000. This is one reason that I prefer the routine PCRNA, rather than the ultrasensitive, for a first viral load result; it is helpful to quantify the height of the viral load prior to therapy. Afer that, the ultrasensitive assay, which offers a lower threshold of 50 copies/ml, is more useful to monitor the impact of therapy.

You are right that a viral infection - 'the flu' - might also have added to a failure to suppress, or perhaps you did fully suppress, but were not tested at that moment, and then had a blip with the viral infection.

I would also regard the course of your CD4 cell count and percentage, as well as your clinical status, as useful information to make this decision, and note that I lack this and other key information.

So be patient and await your next tests. There is ample time to change, in the event of a virologic failure, but the more likely outcome here a prolonged time to full suppression.

I urge you to talk to your doctor about your concerns and this answer, as he or she has all the information needed to inform these decisions.

Re resistance testing in treatment naive
Can switching meds develope resistance?

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