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HIV Drug ResistanceHIV Drug Resistance
           
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Phenotypic & Genotypic Testing
Dec 15, 2007

I had blood for these two test taken on Nov. 26, 2007 and as of today Dec 14-the results are not back and per the Dr. they are still testing the blood-Everything I have seen reports that results are in within 10-14 days. The Dr. is it could be as long as two more weeks. I very concerned that resistance must be an issue. I am newly postive (Oct 2007) with CD4 of 339 & 17% & VL of 61000. I seem to be the only one worried.

thanks so much

Response from Dr. Sherer

In some ways, this is true. No one will be as concerned about your case and your condition as you and your loved ones will. Having HIV is an enormous challenge - but you would be surprised how many people deal with it magnificently. With a little effort, you can do it too.

One way in which you will be tested is by delays of this kind. Having HIV is a long haul, so you will need to learn patience and to 'be cool' while you wait for this kind of information. There could be one of a hundred explanations for the delay.

And you can afford to 'be cool' right now. You have a CD4 cell count that is not the worst. While I agree with your doctor, and with the new HHS Guidelines of Dec 1, 2007, that a person with a CD4 cell count of 339 should start ART, you and your doctor can take the time needed to get it right, including waiting for the resistance test results that will guide your doctor's recommendation for your first regimen. This is not an emergency, and you want to get this first important choide right.

Once you start treatment, you have an excellent chance - better than 4 in 5 - of having a positive outcome, with full suppression of the viral load, and a rising CD4 cell count of 100 cells/year (or more). In the current era, the chance that you will develop multiple drug resistance once you have started a full three drug ART regimen is less than 5% after 3 years (according to one study).

And the possibility that you acquired a resistant virus is a real one, and that is why your doctor properly has obtained a resistance test before prescribing ART, so that you will be assured of receiving drugs to which your virus will respond. It is quite unusual to have an initial drug resistance test that has multi-drug resistance (1-2%); if your test is at all abnormal, it may have a single primary drug mutation. If that is the case, your doctor will still have many treatment options for you.

So what can you do, other than 'stay cool', to have a magnficent response to the difficult problem of having HIV infection? You have to respect the virus and the limits it imposes on you and your life, but you must not think that it defines who you are, or what your life is worth. When you start ART, you can give yourself (and your loved ones) the best possible chance for your best treatment outcome by taking every dose as its prescribed, and talking to your doctor regularly about any side effects or other problems that you may have. Since you are still HIV positive, and you will still be HIV positive when you take ART, you will need to continue to follow safer sex recommendations. This is another important way in which you must respect the virus.

Finally, you'll need to find creative ways to let go of the tension of having HIV in your life and enjoy yourself - regularly, often, for long periods of time - even while you do these things above to pay HIV its due respect. What would you do if you had diabetes? Hopefully you would deal with the issue, take the medication, and take care of yourself, without freaking out while waiting for each blood sugar result.

Be cool, you're in this for the long haul. Ask your doctor what he or she recommends on this subject as well.


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