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HIV Drug ResistanceHIV Drug Resistance
           
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testing and resistance
Aug 12, 2006

Hi:

Happy 25th anniversary, as i was detected on June 1 of this year with a CD4 of 379 and VL of 89,000. I did go to visit a spcecialist (Infectious disease Dr.) I asked for immediate / aggressive treatment. He immediately put me on truvada /sustiva. I had some minor side effects and am awaiting my first counts / test since starting meds in mid june.

1. Should he have done some resistance testing to see what the best meds would be? or what strain I may have?

2. What kind of results can I expect after 60 dyas of treatment?

3. On my last visit he told me I could be taking these same drugs for the rest of my life... is that possible?

thanks for all your candid facts and answers.

Response from Dr. Sherer

In answer to your questions:

1) In the US and Western Europe, it is now considered standard of care to perform a resistance genotype test prior to initation of ART. Surveys have shown that around 10% of chronically infected adults are resistant to one drug, and so resistance testing can inform the doctor and patient about ART drugs to which a patient may respond poorly, or not at all.

The same phenomenon has been reported in other major metropolitan centers around the world, and there is some evidence that resistance is increasing in more recently infected persons, but the actual frequency is highly variable.

So the answer depends on where you live, and what is know about the prevalence of resistance mutations in that region.

2) After 6 months of treatment, the vast majority of patients started on ART with excellent adherence will have a viral load below detection and an increase in CD4 cells of 50 cells or more. (After one year, the average CD4 cell rise is 100 cells)

After 60 days, we expect to see a one log drog in viral load or more (e.g. a decline from 89,000 to <9,000) and no further decline in CD4 cells.

3) Yes, in one trial of 100 on a single ART regimen,two thirds were still on the same regimen after seven years.

In the longest study of your regimen, the majority of patients were still doing well after 3 years.

We are still learning about the natural history of treated HIV infection, so its not possible to talk about time intervals much longer than these, but most HIV clinicians have experience with patients who have done very well on HAART for 5-10 years or more.

Your best opportunity to remain on the first regimen that you ever receive is to take every dose as prescribed, i.e. to be as perfectly adherent as you can possibly be.

I urge you to talk to your doctor about your questions and these answers.


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