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Geno-phenotype
Jan 29, 2007

I have never had one. I was diagnosed Jan of 2001. My HIV doc said there was no reason to do it because since I had not shown med failure it could not give an accurate reading. At the time I was asking for one, I was on a long drug holiday of almost one year. I thought having been off for multiple months at that time, that then would be an opportune time to test me. Please help me understand when such tests are indicationed. Thank you. PS - I went from Combivir/Sustiva, long break, then Truvada/Sustiva, now Atripla. That was my refusal to take AZT again, because of how sick I felt with that first med group, very weak and anemic. Now, with Atripla, I feel great. And FYI: CD4 over 1000 VL non-detectable. Why the stop? My liver was enlarged, painful to the point that I was taking Percocet for relief to sleep. All liver tests were negative. As soon as we stopped the first run, within 2 weeks, liver shrank back down.

Response from Dr. Daar

Thank you for your post.

Antiretroviral drug resistance testing is often recommended for those who have never been on treatment and thinking about initiating therapy for the first time. In addition, it should be routinely performed at the time of virologic rebound while on therapy. In general, with the exception of those who have never been on treatment, resistance testing is best if the person is on an active regimen with a viral load of greater than 500 to 1000 copies/mL. It is not possible to perform these tests if viral loads are undetectable and probably not necessary in most cases if viral load was undetectable in the past on a stable regimen but is now rebounding off of treatment. Of course these are general guidelines and I would encourage you and others to discuss this further with an expert provider since there are times when it might be appropriate to deviate from these recommendations.

I am not sure I completely understand what you are referring to with regards to your liver being enlarged or if this is an active problem on your current therapy. If this is an active problem then further evaluation is certainly needed, including special studies and potential evaluation by a liver specialist.

Best, Eric


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