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HIV Drug ResistanceHIV Drug Resistance
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Aug 2, 2001

I have been over 2 years undetectable on Rit/Fort/D4T/DDI/sustiva. Previous use of AZT/3TC/DDC/Saq (diagnosed 1/96 with baseline 65,000 VL and 210 T-cells). My last two VL counts were detectable at 55 and 250, with T-cells over 1,000. I did have a cold within a few weeks of both VL counts. I am so scared that I am going to fail now with no options.I especially am concerned over getting a virus resistant to the sustiva class of drugs.Any suggestions/reasons for hope?

Response from Dr. Little

You should clearly have a resistance test performed. There are two types - a genotype and a phenotype. Both are readily available and can offer guidence regarding whether you have developed drug resistance to one or more of the drugs that you are now taking. These tests are very helpful and may suggest that only one drug in your current regimen should be switched out rather than changing the entire regimen.

The difficulty with resistance tests is that they may not tell you whether you have drug resistance to a drug you took in the past. Occasionally, this information does show up, but the absence of detected drug resistance to a drug or drugs that you took in the past cannot be interpreted as meaning that you do not harbor these resistant variants at some low level (ie too low to be detected by the test).

However, either test (I generally recommend ordering the one that your provider is more comfortable interpreting) will help guide your treatment choices. Simply developing a detectable viral load does not routinely mean that you have developed resistance to all the drugs you are currently taking. Good luck.

PEP Questions
Combivir Potency and temperature extremes.

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