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resistance test with low viral load
Jul 6, 1999

Hello Dr! I'm a HIV positive man. I tested positive in 1994. I was one of the first on the saquinavir protocol. From 1995 to the end of 1997 I was on 3TC, AZT and Saquinavir. Since my first viral load test showed around 1600, my doc switched me to D4T, Ritonavir and Nevirapine. Almost immediatly, I had great results. My last results showed VL <50, CD4 around 600. Everything was going fine except very high cholesterol and triglycerides levels wich are under control with lipitor. But in the last 6 months, I developped a major case of lipodystrophy to the point of being diformed (fat around internal organs). My doc is suggesting switching meds but before that, he had me take a drug resistance test (not sure if genotype or phenotype). We're still waiting for the results but here is my question (finally!): If my viral load is under 50 copies, isn't the resistance test unreliable? What could I learn from such a test? And what is of greater risk: the lipodystrophy caused by my actual regimen or switching to meds that might not work as well? I thank you in advance for taking the time to answer me!! :)

Response from Dr. Holodniy

It will be unlikely that the lab will be able to get a result on a resistance test because the viral load is too low. That in fact is a very good thing ( VL <50), in that the likelihood of resistance is almost zero. If you need to switch meds, now is the time to do it. Because there is not alot of viral replication, you can just swap out the ritonavir for an additional potent agent or two (abacavir, ddI?).


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