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Resistance test before starting meds?
May 8, 2001

Hello Dr...I tested HIV+ 4/99 and have not been on any hiv meds yet (my counts are good....vl usually around 5,000, cd4 mid 500's). I'm wondering if it's a good idea to get a resistance test before starting any of the meds. I would hate to start out on a med combination and then find out i was resistant to one or more of them. Is it routine practice to do a resistant test on someone just about to start the meds? I also tested + for hepC at the same time and have stage 3 fibrosis so want to help my liver out as much as possible. thanks, robert

Response from Dr. Little

While I will not argue against resistance testing, my guess is that it will not be very helpful this many years after your original diagnosis. It is possible to acquire drug resistant virus, but there are several issue to consider. First, the transmission of drug resistant virus was relatively uncommon in the 1998 and before period. Second, in the absence of treatment during the last several years, it is quite likely that even if you had acquired a drug resistant form of the virus, it would have reverted or changed back into a more sensitive form over time. Thus, a negative test at this point will not exclude drug resistance even if it is present. So, a negative resistance test may be reassuring to you and your doctor, but there is not a strong medical indication for testing this far out from initial infection. Given the concern that you raise about your liver and your relatively low viral load and high CD4, you should also have a detailed discussion of the risks and benefits of therapy in your circumstances before starting therapy as well.

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