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Rare case from the UK
Jun 17, 2007

My post of 4th May (same title) refers.

We seem to agree that a genotype resistance test is worthwhile in my case, because (to risk repetition!!!) the PCR test relies on the genetic sequence of the primers it uses to be complementary to the genetic sequences of the virus that is being detected. If there are certain kinds of mismatch, the virus may not be detected, and the test will not work. The resistance tests use different [amplification] primers to detect the virus, and thus may pick it up in the rare cases where the other tests (including the viral load test) do not. However, nobody is prepared to do this test here because it is difficult to sequence any virus when the viral load is less than 1,000 copies/ml. It seems to me that Im in a catch 22. Surely, if there is a mismatch between the genetic sequence of the primers that the PCR test uses and any (rare/mutated) virus, it wouldnt be possible to measure the viral load in any case. Hence, a genotype resistance test should be done anyway. Is there something wrong with my logic?

Response from Dr. Conway

No, your logic is fine. In most tertiary care settings (including our own), all that is needed is to explain the situation to whomever is in charge of the laboratory and such supplementary testing will be done. If the result is negative, however, and your situation is unchanged, you now need to be able to accept this result and move on. I truly hope that this is the case for you.



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