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How is trreatment determined?
Jan 22, 2002

I must decide soon about going on meds, I would like to know what determines the best regemin.

Should a geno and pheno type test be preformed first?

Response from Dr. Little

The choice of what to start and when to start is a very complex topic. In general the decision of when to start is most influenced by your viral load and CD4 cell count. The choice of what to start is most influenced by your lifestyle and the risk/benefit ratio for you of the different regimens (there are now many choices).

In terms of the resistance test (genotype or phenotype) - there is not a general recommendation to obtian this test before starting therapy at the present time - HOWEVER - I personally feel that this recommendation will change in the near future. I think that there is enough data on the transmission of drug resistant virus and the persistance of some of these resistant variants to warrent pre-treatment screening of most previously untreated individuals. Keep in mind that this is my opinion and not a widespread recommendation. The finding of drug resistance may substantially change the initial treatment recommendation and on this basis and the observed frequency of resistance in the community - I think it is reasonable for most individuals.



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