Oct 7, 2007
With the advice of a peer to bring this to the EXPERTS, here it goes. I had complete resistance analysis done a yr. ago. Have been poz 23 yrs. At the time of testing I was taking Zerit, Viramune, and Epivir ( for approx. 12 yrs.). Previously AZT for a number of yrs. These have been the only regamins I have been on in the 23 yrs.. My vl was fluxing between 0 to 100 copies every other lab,or so. My cd4 has always been 400 -500+ range and never lower. He (Dr.)suggested the geno / pheno testing with the statement: " you may be experiencing some resistance to some or all of the medications. And changes may be needed in medications. So as a compliant patient, I agreeded to test. When the results came in the labs stated: Resistant to: Emtriva, Viramune, and Sustiva. (I don't know the compounds involved in these medications)although I do know I have never taken Sustiva. So with having the report in my hands finally after more than a yr. to aquire, going thru some hoops as well, and after talking with several friends who are poz. they stated that geno / pheno-typing can not be done with less than a 1000 copies (vl) The report states: this test may be unsuccessful is the plasma HIV RNA viral load is < 1000 copies of the virus per ml of plasma measured with the Apmlicar(r) HIV Monitor test (Roche Diagnastic). How accurate it this specific test? are their other geno / pheno-type test available or is this the only one? When I go to the Web site for vircoTYPE HIV-1: the site states the test accurately reads vl < 50 copies 70% of the time correctly. Can you shine some light on statistcs for me please?
Response from Dr. Daar
Thank you for your posting. Most commercially available resistance tests will warn that they may not be able to report results for those with viral loads less than 500 to 1000 copies/mL. That said, there are times in which the test will be successfull with lower levels of virus. There are research assays being developed to work at lower levels of viral load but for now there is little reason to think about using a diferent test.
It is possible that your report would say sustiva resistance even though you have never been on it before because those who develop resistance to viramune will often be resistant to sustiva. The same is true for emtriva where those that develop resistance to epivir are typically resistant to emtriva. I would have your provider go through the resistance test in detail and make sure that the mutations they report is consistent with your treatment history. If s/he thinks the results are reliable this information will assist in the development of a new regimen. Best, Eric
Concern regarding NNRTI resistant transmission
viral load increase
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