Virus suddenly stops being resistant?

[jerry7171]

I've tried searching the forums here and it didn't really pan out, so here goes...

I've known my poz status since April, 2005 and have mostly been on treatment from nearly the start.  How long I had the virus is anyone's guess but probably for at least five or more years prior.

I stopped the cocktails last November after suffering some pretty ugly side effects from Norvir.  I had previously had Reyataz in its place but my liver took a beating from it and I had to switch (very unhappily) to Norvir as a supplement to my cocktail.  My doc at the time told me bluntly to get over myself and just man up and stick to the meds.  I stopped instead.

Funny thing is, my CD4 count actually improved over time from then and the virus mostly stayed at a static number.  I wasn't undetectable anymore, but the viral load was low.

Since May, I've begun to have serious memory lapses.  I apparently do & say things that I have absolutely no recollection of.  My friends have been really worried about me.  They tell me that my personality is starting to change in bad ways, like being volatile and extremely hostile to anyone I perceive as having wronged me in some way.

Some simple things like my computer password to get online suddenly escape me, or I've forgotten how to use my EBT card at the check out.

Just recently, my latest CD4 counts went from around 700 to under 300 while my viral load is hovering around 100K.

My student doc I have now told me that the latest genotype of my virus indicates that I can take any medication with good effects.  This is the crux of my dilemma: I was under the impression that once the virus becomes resistant to a class of meds, those are off the table for life.  The class my virus has become resistant to includes Atripla.

Besides that, my student doc pooh-poohed my concerns as expressed by my friends as just simple depression that will go away in time and also said she'd prefer to wait until I'm actually sick before I am started on any meds because of my refusal to comply with the previous doc.  I thought too that it was tougher on a patient to get back to health if he got sick from some AIDS related illness and had an immune system in tatters? 

Am I being stupid or paranoid here?  Does a virus become susceptible to treatment that it had been previously resistant to?

Thanks!
Jerry

[jkinatl2]

What you might be experiencing is a growth of wild-strain virus, which can often overwhelm the more resistant strain lurking in your organs/brain/lymphatic system. That's a huge oversimplification BTW.

I registered as "wild strain" myself after being off meds for several years. Only when I resumed therapy and my viral load plummeted did the resistant strain emerge. Luckily I continue to be at least somewhat susceptible to all meds, from a resistance POV.

I would be worried as hell about the personality changes and memory lapses. That would be enough to get me back into ART, numbers notwithstanding. It is my understanding that much of HIV's activity in the brain cannot be easily reversed, if indeed it CAN be reversed.

I certainly hope you push for a thorough diagnosis of your CNS issues.

[mecch]

What is a "student doc"?

Is she a shrink, by the way.  Sounds like a gamble on your part, and a guess on hers, to say your changes are result of a depression and not HIV.  Can you go to a shrink and get evaluated for depression? If you can't, then why not start HAART again.

Even if you are depressed, why avoid HAART, now that the possibilities for combinations are open again?   

Hard to believe your doctor wants you to be "sick" before reconstituting a healthy immune system, again.  Eventually to live, you'll need the HAART.  Gambling on 6 months more, maybe, without meds is worth the risk???

[eric48]

Hi,

You may want to confront your 'older' resistant genotype with more modern NNRTIs profile.

Newer options such as complera or quad or alternatively Isentresss+ truvada may be a  good choice if you woud want a PI sparring combo.

Yours being able to control the virus somehow after meds interrupton is called secondary control. Rare but not unheared of.

Docs have a hard time admitting it becuase secondary control is the result of a treatment interruption that docs would normally oppose.

Depending where you live there may be some other clinics/hospital and doctor shopping might be a good idea. Not providing all of your medical history may help as well.

Cheers Eric

[newt]

In short, you are not paranoid and your doctor is a student who is still learning how to treat HIV properly.

Mutations that make HIV resistant to NNRTIs like efavirenz (which is in Atripla) tend to hide away when treatment is stopped and not show up on resistance tests.

The resistant HIV will probably re-emerge if you start on an older NNRTI again. Personally I would not take nevirapine or efavirenz if a previous resistance test showed I had HIV that was resistant to these drugs, whatever a new resistance test shows. A newer NNRTI like etravirine may overcome the resistance.

I agree with your concerns about your memory lapses etc, and therefore reconsidering starting ART. Waiting til you are sick(er) to go on meds again is a stupid strategy in my book. It does not increase the chance of your adherence being good. A combination with very few side effects seems to be the key here. 

- matt

[Rockin]

What you might be experiencing is a growth of wild-strain virus, which can often overwhelm the more resistant strain lurking in your organs/brain/lymphatic system. That's a huge oversimplification BTW.

I registered as "wild strain" myself after being off meds for several years. Only when I resumed therapy and my viral load plummeted did the resistant strain emerge. Luckily I continue to be at least somewhat susceptible to all meds, from a resistance POV.

I would be worried as hell about the personality changes and memory lapses. That would be enough to get me back into ART, numbers notwithstanding. It is my understanding that much of HIV's activity in the brain cannot be easily reversed, if indeed it CAN be reversed.

I certainly hope you push for a thorough diagnosis of your CNS issues.

What kind of HIV activity in the brain? I never heard of that. HIV can affect one's brain?