discordant genotypes

[John2038]

never been on meds
first gentotype made 10 months ago showed 2 majors NNRTI and 2 others major NRTI mutations (vl=3k)

ready to start meds, i made recently a second genotype (vl=3k) which showed no major mutations

what should i conclude in terms of treatment ?

note
writing this post with my pda waiting to board flying back to EU
just got my gentype an hour ago
minor mutations


thanks

[newt]

Not an NNRTI

NNRtI mutations tend to fade pre-treament but are prone to re-emerging << not good

Nuke mutations may/may not be important, what are they? Conservartively, combo to start could be boosted PI + Truvada and a close watch on response, depends on nuke mutants.

But deffo not an NNRTI

 - matt

[John2038]

previous mutation by memory

103 108 215 184
plus pi minors

now no major (sensitive all)

what do you means by not nnrti ?
thanks

[newt]

Although the 184 confers high-level resistance to 3TC and FTC, it confers hypersusceptibity to tenfovoir (Viread). Therefore Truvada aka tenfovir + FTC is probably the best nuke backbone, unless you wish to add AZT.

103 mutation = bye bye Sustiva and Viramune. Hence comment that perhaps boosted PI is best conservative first-line option.

More complex lilke, boosted Prezista + Intelence (maybe with less nukes) or another super-modern combo may be an option, but, personally, I would wait and see what a boosted PI would do first.

- matt

[John2038]

so the second genotype , which shows no mutations is meaningless and cant allow to conclude that either some mutations have fade away nor the first/second genotype was a mistake ?


thanks for all your great ideas  for combos
highly appreciated matt

will do a tropism in eu. if r5 thinking also maraviroc + drv + ?
what can be added to that u think ?

thanks again
john

[newt]

personally I don't like Maraviroc cos, relatively speaking, it's weedy, but true, an option. With DRV would be hard to tell if it's doing anything cos DRV is so super strong.

Faded mutations often have a rebirth if challenged eg by appropriate drug, one of the biggest causes of treatment failure. 1st genotype is most accurate.

- matt

[John2038]

thx matt

just for info, there is a new tropism assay available since last july in the US.

relatively poors results with maraviroc (60% or so undetectable at wk48 -was it in merit study?) were very probably due to innacurrate screening (older trofil assay unable to accurately detect r5 only)

in more, in favor of the maraviroc is maybe the fact that in cause of failure, it might not compromise others meds

also, with time r5 might mutate to r4/mix and so nice to use it in a first line no ?
but im 100% sure all this is known by all here !

just sharing concerns about discordant genotype

[atlq]

John,

If you get an accurate tropism, then your logic is sound. If you have r5 now, it might be worth considering, particularly since, as you stated, a conversion to r4 is probable for most of us at some point in the future, rendering maraviroc useless at that point.

However, it seems from the geno info presented that Truvada and  a boosted PI combo should be first on your list for consideration. Truvada is pretty kind in terms of side effects and Reyataz/Norvir would also be a pretty powerful combo...

[John2038]

thx matt and atlq

mutations in the first genotype are proabably "archived mutation" so I have been lucky to have made this genotype shortly I learned that I have been infected

now I'm wondering if some studies highlight cases where some mutations have totally disappear

[John2038]

Went to Europe recently to meet a HIV specialist and discuss with her starting a treatment.

She ordered a 3rd genotype, and submitted the two I made so far (in a developing country, but does it matter ?) to the laboratory chief of this EU lab.

Immediately, the laboratory chief told to my ID doc that the mutations in both genotypes are not compatibles for many reasons that will be given to me at my next appointment.


They are currently trying their best to identify the mutations mentioned in the first genotype (the second identified no major/minor mutations but "others"). But this task is a bit difficult due to my VL (595) during this blood draw.

I will let you know the reasons why 2 genotypes can be contradicting, for those for which such info can be of any interest.

My personal conclusion is: if you have to do a genotype, do 2 genotypes from 2 different labs.
Even if you should pay for one.
The conclusions of a genotype are so important that it is worth to exclude any mistake.