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Trofile Test/What does it change?
Jan 9, 2010

I have been a hard to treat patent, seeming it's always been the PI's that have given me problems. I got sick from reyataz/norvir after taking it for 2 years. Had terrible pains in my belly and gastric reflux. I also had or horrible manic "cycling episodes every time I swallowed a sustiva which was 3 times. I found epzicom is a great nnrti/nrti to which I have no effects. My ID wanted to do a trofile essay test to see if my virus was entering the cell through ccr4 or ccr5, well it came back dual mixed. What does this have to do with my treatment and what can or can't be done now that she knows this?

Response from Dr. Frascino

Hello,

You mention "epzicom is a great nnrti/nrti to which you have no effects." Actually epzicom is abacavir plus lamivudine. This is a combination of two NRTIs (no NNRTI). Epzicom alone is not considered adequate treatment. You need another antiretroviral on board!

The Trofile test is done to see if you would benefit from a CCR5 co-receptor inhibitor drug (Maraviroc).

For the benefit of our forum readers who are not familiar with this topic, I'll briefly explain. CD4 cells that can be infected by HIV can have different types of chemokine co-receptors on them. The two co-receptors are termed CCR5 and CXCR4. HIV viruses are either R5 or X4. The R5 viral strains enter with the help of CCR5 co-receptors. Similarly X4 viruses enter with the help of CXCR4 co-receptors. Tropism refers to which co-receptor HIV uses to enter a CD4 cell. R5-only virus usually predominates in early HIV disease, while X4 virus is most often associated with advanced disease.

Trofile is a test of HIV viral tropism. Dual-tropic viruses can use either CCR5 or CXCR4 co-receptors. Mixed-tropism refers to a viral population that contains both CCR5 and CXCR4 viruses. The Trofile test cannot differentiate dual-tropic from mixed-tropic virus; thus, the term "dual-mixed" virus has emerged.

Maraviroc (Selzentry) is the first chemokine co-receptor antagonist to be FDA approved. It blocks CCR5 co-receptors, thereby blocking CCR5 virus from entering CD4 cells. It, unfortunately, is not effective against CXCR4 viruses and therefore is not recommended for folks with X4 tropism or dual-mixed tropism.

As for what else you might consider, talk to your HIV specialist about the integrase inhibitor Isentress. It may be a good option for you.

Good luck.

Dr. Bob



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