Twice Lab Failed to Perform Genotype Drug Resistant Testing Even Though I Had Enough Viral Load

Question

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. When I was first diagnosed HIV-1 in mid July 2018, my viral load was 15,500 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 use for undetectable viral load)?

  3. 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.

  4. 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.

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

Thank you very much for helping! I really appreciate it.

Answer

Sometimes this happens with resistance testing and the commercial labs are not going to provide a reason for the inability to get a result, other than what was said. A viral load of 15,000 is more than sufficient to get a result. It is unlikely that this is related to a "rare strain". Although a Genosure Archive is performed with different proprietary reagents, it is not necessary in your case given your excellent response to treatment. So you don't need to worry about drug resistance.