Recently diagnosed and already have two drugs with drug resistance

Question

I have recently been diagnosed with the HIV virus and am having different blood testing done. I received a copy of my Lab work and out of 19 different HIV drugs two of them show that I have resistance to them before I have even taken any HIV medications. They are Sustiva and Viramune. How can this be if I've never taken these drugs? Also in my research of medications these two are at the top recommendations of the Department of Health and Human Services for the treatment of the HIV virus. I am trying to learn as much as possible about the treatment although I am hoping I won't be needing it for sometime. My CD4 =1430, CD4% = 32 and HIVbDNA, viral load = 12,741. Any information will be appreciated. Thank you.

Answer

Most likely, you have these mutations because you acquired a virus from someone who had taken one of these two medications, acquired these mutations, and then passed the virus on to you. Alternately, the person from whom you got HIV might have acquired the virus from another person who was taking one of those two medications and passed the virus to him or her.

These two drugs are NNRTIs, non-nucleoside reverse transcriptase inhibitors, and they have the same resistance mutations, so when you are resistant to one, you are resistant to the others.

You and your doctor will benefit from knowing about the presence of these mutations, so that no time is lost, and you are not exposed to unnecessary toxicity by taking these drugs with no prospect of efficacy. Instead, you and your doctor can choose an alternate regimen, as listed on those DHHS ART Treatment Guidelines that you have been reading.

As you suggest, no treatment is needed at present. Be sure to continue to see your doctor periodically, e.g. every 6 months or less, for regular viral load and CD4 cell count testing.