Treatment Naive and Viral load roller coaster



I'm a 44 year old male. Aware of my date of contraction and had acute symptoms that alerted me to the situation. My initial Viral loads were 500-600K but that was still while I was in the acute phase. I immediately enrolled in a trial for acute HIV. My physicians initially began treatment on Sustiva and Truvada. A month later my viral load was dropping and then plateaued at 2400. My physicians then added the new formulation of Kaletra . A month later my Viral load had dropped further to 240 and We thought that I was well on my way to undetectable. two weeks following the 240 viral load I had another Viral load drawn and the results are back and it went back up to 600. I have had the genotype done. Not sure if a phenotype was done but my doctor had detected some "fossils" of resistance in the first genotyping to Sustiva and some other drugs, I have been religious about taking my meds on time and have not missed one dose since starting them 3 months ago. I realize you need to know a great deal more about my case to really make knowledgeable recommendations. But since the trial is aimed at treating Acute HIV and treatment Naive subjects I guess I still have quite a few treatment options. My question is will switching to another PI make a difference and are there other PI's that will be as potent as Kaletra or as affective? Also is it useful to continue taking the Sustiva if the Genotype indicated that there might be some resistance? I'm sure that I'm leaving a lot of information out that you need but the gist of my worries is that I'm concerned I might have a multidrug resistant strain and am just starting out on a long road of multiple drug variations.



It is unfortunate that the first regimen did not get your viral load to undetectable levels. I suspect you may have acquired a drug resistant virus that led to the less than optimal response. If the genotype only showed resistance to sustiva I would be optimistic that follow-up viral loads on Kaletra with Truvada should show a decline, hopefully to undetectable levels. If this does not occur an additional genotype should be performed to see whether you have developed resistance to tenofovir and/or FTC, both parts of truvada. Without evidence of protease inhibitor resistance it is unlikely that the problem is the Kaletra or that switching to an alternative PI is the solution. Nevertheless, additional information is needed, including another viral load on your current regimen in order to best define what your next step should be.

I do not believe that continuing Sustiva in the face of resistance is a good idea. In fact, there are several good reasons to stop it in this situation. Therefore, I would encourage you to discuss this with your provider and serious consider discontinuing Sustiva as you move forward.

Best, Eric