(Few Questions Added) Twice Lab Failed to Perform Genotype Drug Resistant Testing Even Though I Had Enough Viral Load

Question

(Few Questions Added) Twice Lab Failed to Perform Genotype Drug Resistant Testing Even Though I Had Enough Viral Load

Hello Dr. Holodniy! I was tested negative in May 2018 and infected in early June of 2018 (I only gave unprotected oral sex and received fully protected anal sex with few gay men in the first week of June in Europe). When I was first diagnosed HIV-1 in mid July 2018, my viral load was 15,500, CD4 was only 344, and I had a genotype testing failed to perform due to insufficient amplification of genetic materials. Then I tried a second time with the same lab company (Lab Corp) 8 days after I started taking Biktarvy(still in July), the testing was failed to perform again due to the same reason.

  1. Could it be my virus type is very rare that it is not suitable for the lab assaying methods and potentially resistant to many kinds of drugs? I am very worried.

  2. Is there any case like mine before? Were they eventually able to determine the genotype by using other labs or Genosure Archive(The one Lab Corp in USA use for undetectable viral load)?

  3. Why my CD4 was so low (CD4=344) for only exposed for around 40 days? Could it be that I am infected with some super dangerous strains? Also I think I had acute HIV symptoms only a week after being exposed.

  4. Two weeks after taking Biktarvy, my VL has dropped to 30, however I tested it again 4 weeks after the meds (2 weeks after the 30 copies test), my VL went up to 40 copies. Is this normal? I was expecting it to be below 20 already.

  5. Could it be that the remaining of 40 copies/ml are the resistant strains which will begin to replicate soon and dominant the virus pool?

  6. Do I need to worry about drug resistant since I don't have a genotype result and I don't know whether is one out of three combination work against the virus or all of the three combinations work.

  7. What if only one drug is working, how long does it usually take for virus to develop resistant with it (under perfect adherence)?

Sorry I ask so many questions at one time, hope I organized them well enough for you to understand. Thank you so much for helping!

Answer

Again, I am not concerned about drug resistance in your case given your excellent response to HIV treatment.