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HIV Drug ResistanceHIV Drug Resistance
           
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resistance testing
Jun 6, 2001

i have been off meds for over 1 yr now cd4's 153 4 & v'l 7,200 these counts are not much different than when on meds my cd4's have never gone over 212 but i have been undectable i have alos known for 11 yrs that i have aids~~ now i asked about a resotant test being done i know i will need to get back on meds~ i was told it couldn't be done unless i was on meds or it would show resistant to everything`~ now i have heard different opinions on this too please help

Response from Dr. Little

It is true that drug resistance testing is of greatest use in people on therapy at the time of the test, or those that have recently stopped therapy. However, some of the drug resistance mutations may persist longer than others and occasionally, even in people off therapy for several years, some of the drug resistance mutations that developed while on therapy in the past will persist and be detected.

Given that the yield is lower though, I often try to put together the best regimen possible based upon your prior treatment history (with careful attention to what drugs you might have failed and what drugs you simply did not tolerate). Based upon this, it should be possible to come up with a reasonable treatment regimen. Then, I would follow your viral load closely after you start this regimen and do a drug resistance test if you are not responding as rapidly as I would expect or do not achieve an undetectable viral load by about 20 weeks.

If it is impossible (based upon difficulty remembering and limited documentation in the medical records) to come up with a reasonable prior treatment history, then I would still do the above (start therapy with the best regimen possible) and then do drug resistance testing to refine this choice of regimens if resistance to one or more of the chosen drugs is detected. Drug resistance when detected is always useful information to know about. The difficulty is that failure to detect drug resistance in someone who has been off therapy for a prolonged period of time does not exclude the possibility that drug resistance is present, but at such a low level that it can not be detected. In the later circumstance, one would expect the drug resistant variant to become the predominant variant (and much more easily be detected) if the drug in question (the one to which resistance is present) is started. That is why many people wait until a suboptimal treatment response is observed before doing the test in the circumstance you describe.


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