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Interpreting resistence results
Jun 14, 1999

Dear Dr. Holodniy,

I have been HIV positive since before 1984 (I am in the MACS study and my initial screen was positive when the study begain). I have been on meds since beginning AZT in 1989. Recently I was on D4T, 3TC, and NFV and was undetectable, but then VL went up to 311 with CD4 at 450, right after a cold. One morning I awoke with mod to severe abdominal pain and went to the ER, where they found I had elevated lipase and amalyse and glucose at 211 (I have also been on lopid). We dc'd all meds, then a few days later my MD started me on NFV, Fortovase, and had me add back the 3TC. Lipase started to go back up so he dc'd the 3TC.

I said I wanted to stop meds, get VL over 1000, and do genotypic testing. After 3 days the Vl was still undetectable, but went up to 29,000 after 2 weeks so we sent a sample to Labcor for genotypic testing. After 2 weeks the results were not back yet, and we both were getting nervous, so we started Sustiva and Ziagen.

Now I have read that the genotypic testing should be done on meds or the wild type virus will "color" the results. What do you think? Thanks for plowing through this complicated picture.

Response from Dr. Holodniy

It's a two edge sword. You need a certain amount of virus to be present to do resistance testing. A 1000 copies/ml is usually the minimum. So people on meds with lower viral loads will not get any information. After a certain period of time (the exact time is not really known), wild type virus will repopulate the blood. In your case, after 2 weeks, you did get your virus back up so technical issues shouldn't be a problem and in my opinion there should still be enough resistant virus present if it was there to begin with. MH


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