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HIV Drug ResistanceHIV Drug Resistance
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Resistance test accurate?
Jan 4, 2008

I was infected in early June 07. A resistance test done in September did not indicate any resistance. Is 3 months too long of a period after intial infection to detect resistance? I want to thank you Dr. Sherer. I only knew to ask for a resistance test because I had read about here in this forum.

Response from Dr. Sherer

You're welcome, but you should save your thanks for your doctor. He or she is the most important person who can help you avoid drug resistance in the future. And you yourself are in the driver's seat when it comes to preventing resistance. You can give yourself the best possible chance to prevent resistance by taking your medications as prescribed with no lapses.

3 months is not too long a period after initial infection to detect resistance. However, it is possible that you acquired a virus with one or more drug resistance mutations (as an average of 7-9% of people with recent HIV infection in the US do), and that that virus was present in fewer than 20% of the circulating virus in the blood, and thus was not detected in your resistance test.

Fortunately, the risk of an impact of a transmitted drug resistance mutation under these circumstances on your treatment is quite small. Even if you have one such mutation at a low prevalence, for example, it will more likely than not be managed by the activity of the three drugs in your regimen. This is one reason why ART regimens are comprised of multiple drugs.

You and your doctor should monitor your progress closely to watch for the expected decline in the viral load in the first 3 months and the gradual rise of 100 CD4 cells or so over the first year of treatment. Your doctor will repeat the resistance test if it appears that your response is sub-optimal.

Phenotypic & Genotypic Testing Update
Atripla Resistance

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