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Phenotypic & Genotypic Testing Update
Jan 4, 2008

You were kind enough to answer my question on Dec. 15th about Phenotypic & Genotypic testing. The results came back today as the following;

Test Not Performed: WE WERE UNABLE TO AMPIFY VIRAL RNA TO SEQUENCE THE PROTESE AND THE REVERSE TRANSCRIPTASE GENES. THE LIKELY REASONS FOR FAILURE ARE INSUFFIEIENT VIRUS OR AN INHIBITORY SUBSTANCE IN THE SAMPLE. CORRELATE RESULT WITH A RECENT VIRAL LOAD TEST.

I gave additional blood today. I am not a drinker and have never done any drugs including pot.

The cd4 was 313 & 17%, Vl of 61,000 on 11/6/2007.

My question is should I be concern about 100% resistance?

thank you and have a happy holiday.

Response from Dr. Sherer

I don't have access to longitudinal information in these emails, so I don't have any of the information from your first submission.

Technical difficulties are common in new or complex medical tests, and a genotypic resistance test is both relatively new and complex. Failure to sequence the virus occurs occasionally, and signifies only the need to repeat the test. Clearly, if your viral load at the same time as the resistance test was 61,000, the inability to sequence the virus was not due to 'insufficient virus', as the report suggests, but rather to other reasons.

If this recent viral load was done at a time when you were taking your current regimen, it does represent virologic failure, and you should be concerned about resistance. Hence another resistance test and an alternative ART regimen are warranted.

You and your doctor should simply repeat the test, and then you can put the results in context with your recent treatment and response history.


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