Confused about resistance issues, please explain!

[TabooPrincess]

I'm in the process of discussing what treatment to start on at the moment with the hope and intention that this is within the next few weeks (given my numbers are not so great anymore).

The problem being that my doc has 'hinted' towards me being resistant to truvada because the man who infected me is resistant to it (although this is all very cloak and dagger as I'm sure they're being careful about confidentiality).  Now, the ex has never been on truvada AND I was tested for resistance in pregnancy and have nothing.  I'm confused - does this make sense to anyone at all?  It's driving me mad thinking was he on meds in the past and so knew his status all along (but wouldn't that mean he passed that resistance to me during pregnancy), or has he slept with someone since and become resistant.  Blah blah blah

As far as I'm aware he's only been on one treatment regime (kivexa, kaletra and viread) and despite being quite terrible with it has not become resistant.

Please someone explain all this - I'm worried that my medication options are now limited but I don't fully understand how or why 

[leatherman]

can't you just get a genotype test done on yourself, instead of everyone guessing? Your doctor might as well guess that you have NO resistance. without any legitimate proof (and going by what someone else took, or what someone else "might" be resistance to is no proof whatsoever) your doctor is just blowing smoke at you.

[buginme2]

If your doctor is determining your resistance profile based on a hunch and not from the results of a genotype test, I'd find a new doctor.

[TabooPrincess]

I am waiting on the results from the resistance test but she told me that it doesn't always show up properly with the resistant strains.  I really don't understand it all.  I just thought it was resistant or not?!  And the rest is more just confusion as to why things 'may' be different now when I've not had unprotected sex since i was preggers.

[newt]

Bumby bumby rubbish doc, docs should be clear not hint.

1. Resistance is either transmitted (ie you got a resistant strain in the first place) or acquired by not taking drugs properly (ie the virus get the chance to change because the meds are not suppressing it).

2. HIV is always a mix, and sometimes resistant strains are hidden, and only come out on taking treatment. These do not always show up on resistant tests. The only way to detect these is when you take meds and your viral load don't go below 50.

3. If the man who gave you HIV is effectively treated on his combo then regardless of what the tests say you are likely to respond well to treatment using similar drugs to him (or maybe one less, Kivexa + Viread is kinda 1 drug too many maybe).

4. Truvada resistance is not straightforward. The most common mutation which in theory show one of the drugs in Truvada to be ineffective can sometimes make this pair of drugs more effective.

5. That your viral load dropped so well when you were pregnant on a combo containing Viread suggests, practically, Viread will work for you. However, you only took Viread for a few months, so maybe not quite long enough to tell.

6. Do you have your resistance test results? This would allow a more informed comment.

Hope this helps.

[TabooPrincess]

Thanks Newt - that did help.  I am really keen on starting on one of the one pill a day regimes but I'm now concerned that they may not allow me to do this now.  You say that resistance sometimes doesn't show until you are actually on the combo - so would it be sensible/wise to start on a one pill a day regime and hope for the best?  Or if there is a question that I am resistant to truvada (even tho it may not show as it's 'hidden') then wil I have to have something completely different?

Hope this makes some kind of sense....?!

Still waiting on the resistance results which apparantly takes around 6 weeks to come back - but if it may be 'hidden' anyway then what's the point?!! lol