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Why aren't I resistant?
Jun 21, 2006

I had two questions. I am not complaining about being resistant to my meds, I am just wondering how it is after missing countless doses (Reyataz, Truvada, Norvir) I am not resistant. My doctor implied to me that missing one dose could do it, but I have missed tons. Is this just luck on my part or was my doctor exaggerating? Also, I have a question regarding viral load tests. I have been undetectable since starting meds. However, I noticed that my previous doctor used a methodology where undetectable was less than 50 copies and this doctor is using a method that less than 400 copies is undetectable. Is it possible then that I could have between 50 and 400 copies and if so, would that be significant since I've missed many doses of meds?

Response from Dr. Daar

Thank you for your post.

I am glad to hear that you are continuing to do so well on treatment. Nevertheless, you are taking a chance by missing many doses of medications. The fact that you have gotten away with it thus far is fortunate but there are no guarantees that this will continue. The medical community realizes that not everyone will need to always be 100% adherent with their medications. However, we also know from experience that just because resistance has not developed yet, doesn't mean that it will not. Unfortunately, once it happens it is too late. It is for this reason that I encourage you to discuss with your provider how frequently and why you are missing doses. S/he may be able to give you some suggestions that will facilitate you taking your antiretrovirals with more consistency.

Different assays do detect down to different levels. It is possible that you have been in the 50 to 400 copies/mL range. While the significance of this may vary from person to person many believe that the durability of viral suppression will be greater in those with <50 than those between 50 and 400 copies/mL. I would discuss with your provider whether there is a reason for not using an assay that detects down to 50 copies/mL.

Best, Eric


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