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HIV Drug ResistanceHIV Drug Resistance
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Is it a waste of money?
Jul 24, 2001

Thanks for your work on this forum.

My viral load climbed to 5,000 from less than 500. Thinking it might have been a mistake my Dr. had me retest and it can back at 50,000 (for lots of reasons this took 5 months). Now, I'm inclined to get a geno. In doing a little research it seems that with my apparent drug failure - and delay in getting the geno - that since the wild type virus is probably the predominant virus - my drug mutations will not show up.

I don't know if I've completely miscontrued the science ... but I don't have 850 to throw away needlessly. Would you recommend I get the test. Should I get a Pheno as well?

I had both tests done about three years ago - and although I've been positive 15+ years and extensively drug experienced they showed I should be sensitive to all drugs in all classes with only a v77i mutation.

Again, thanks for your work.


Response from Dr. Little

I am assuming that you "failed" your current antiretroviral combination at the time your viral load was detected at 5,000 and then 50,000. If this is the case, then I would strongly suggest that you have a resistance test - these tests are quite good at detecting drug resistance to drugs that the person IS CURRENTLY TAKING. The problem arises in detecting resistance to drugs that you are not taking (ie. took in the past). These drug resistance mutations (in your case V77I) may not persist after your previous drug regimen was stopped. If all of your previous resistance testing was done AFTER you had stopped the failing regimen, then you may never have seen the resistance mutations which arose while on a particular regimen.

Alternatively, if you stopped your "failing" antiretroviral therapy and then saw the rise in your viral load to 50,000, you might or might not still detect the drug resistant variant(s) responsible for your treatment failure. I am still inclined to do the test, since the detection of resistance will be useful if found.

Regarding which test to order - I think that both phenotype and genotype testing offer valuable information that is somewhat non-overlapping. But, I generally advise that the best test to order is the test that your care provider is most comfortable interpreting. That is, the genotype may give you a bit more historical information, but this test can be more difficult to interpret. Either test may help guide you to a better treatment regimen though.

Resistance/Clinical Trials Question
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