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HIV Drug ResistanceHIV Drug Resistance
           
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Newly infected - resistance issue
Nov 1, 2001

Hi, I am recently infected less than 2 mths and am hooked in with a private dr. and another dr. at a research facility. my viral load #'s are decreasing tremendously to under 3K without meds. with a high absolute cd4 of 1425. Should I get a phenotype test now which I pay for or in three months(free)which is part of the research study. It seems that my options are wide open, but I am thinking of going on cycle therapy within three months of my exposure. I may have the name wrong but by cycle therapy I guess I will be on meds for a yr. or so, then off then on again, to see if my viral load decreases even more. What do you think of this cycle therapy? A dr. friend of mine believes that I should start therapy now, get my viral load to undetectible asap and stay on drugs without interruption. Does cycle therapy cause resistance to the drugs that you are coming off of? Thanks so much for your opinion. Keep up the good work!

Response from Dr. Little

I do believe that you should have a resistance test before you start therapy. As far as timing, this is difficult to predict - early data suggests that many transmitted drug resistance mutations persist for many months in the absence of therapy, but what if you end up not qualifying for the study. In general, I think that the yield of early resistance testing is so high (ie so informative) that I recommend proceeding as soon as possible. This is my best guess though since I think the data to address your question more directly is still incomplete.

With regard to cycle therapy. There are several trials for newly infected subjects to start potent therapy for a period of one year and then (if their viral load is sustained at <50 copies/ml) they undergo a series of treatment interruptions to see if their immune system can control viral replication without the aid of antiretroviral therapy. I think that this is a very worthwhile study objective and the preliminary data in VERY SMALL numbers of patients has been quite promising. The risk of developing drug resistance in these studies is thought to be quite small - but not ZERO. As with all studies, I recommend that you discuss fully the risks and benefits of such an approach with your doctor and the study doctor before determining whether this is the right choice for you. Depending on what your personal goals are for your own health, this may or may not be an ideal fit for you.


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