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Have I become Drug resistant?
Oct 9, 2006

I found out that I was HIV positive April 5, 2006. I started Hart treatment Truvada and Sustiva on April 14, 2006 because my numbers were Cd 195-VL 700,000. Next test May CD 540 VL 7000.Started on Atripla July 21= CD 430 VL 800. September 18 CD-380 VL 120. My Doctor feels that I should have been undectable by my September blood test. So he added abacavir 300mg twice a day On September 19,2006 to my HART treatment. Since I have not achieved undectable VL counts and declining CD counts I was wondering if I am becoming resistant to One of the medication in Atripla? I have never missed adherance to any of my meds. Or do I need more time to become undetectable? Pete

Response from Dr. Sherer

This is a common question, and a good one. You are correct that some people take more time to achieve a viral load below detection, i.e. less than 50 copies/ml, often six months or more. Those that need more time tend to have higher baseline viral loads, i.e. above 500,000, as yours was. So with your original regimen, it might have been expected that you would not achieve complete suppression until November.

However, your doctor appears to have been being careful to avoid the circumstance you are concerned with, i.e. the development of resistance to one or more members of the regimen, or even the presence of resistance in the virus you acquired. Even if a baseline genotype was performed, and it showed wild type virus without any mutations, a small percent of those will contain one or more resistance mutations, even though the resistance test did not show them. That is because the resistance test only measures majority species, and cannot detect mutations that are present in less than 20% of virions.

The most important thing that you told me was that you have never missed a dose of medication. This is excellent, and you should do everything you can to keep up that fine record. You have an excellent chance of a long lived positive outcome if you do so.

Bear in mind that your regimen has already achieved an impressive 3+ log decline in viral load, and that there is only a slight difference in a viral load of 120 copies/ml, and < 50 copies/ml. You can also ask your doctor about the percent of CD4 cells, as well as the absolute number, as the percent varies less widely than the CD4 cell count. I am not certain that you have had a real 'decline' in your CD4 cell count with the data you have reported.

I urge you to talk to your doctor about these issues.

'accidental' treatment break

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