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Get a genotype (resistance) test when you first test positive

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I found the following item in the Yahoo Poz Health group. It deals with the importance of getting a genotype (resistance) test done when you first test positive, even if you are not going on meds right away.

Folks, speaking as an HIV doc, I can tell you that people SHOULD get a resistance test when they are first diagnosed--even if they won't start ARVs for years, or never. This is because the mutations sort of "fade" over time. The current test technology is not sensitive enough to see mutations lurking in only a small number of virus particles, but those mutations can emerge quickly in the face of the wrong medicines. Dr. Susan Little at UCSD has shown that some mutations can "fade from view" over 2 years, but they are still hiding out and can affect the success of starting treatment.
I teach my residents that a good history is at least as important, if not more important, as a genotype test. If someone tells me they were taking a drug consistently in the past but still had detectable virus, I'm going to get a good idea of what resistance I'm dealing with, even if their genotype is "clean."
Even though getting a genotype test is a good idea when you are diagnosed, it does not happen in many cases--mostly because HIV care is not an official medical specialty. Many people get care from providers who are not certified by AAHIVM, which is an independent academic society that gives an exam to test providers' knowledge. AAHIVM-certified doctors have to pass an exam testing their HIV knowledge. That's is as good as we're likely to get for having a specialty designation.

Doing a resistance test when you're diagnosed positive has been the standard of care at SFGH Ward 86 for many years; our IAS and national guidelines now also suggest providers do this.
Richard A. Loftus, MD
Davies Medical Center
45 Castro Street, Suite 325
San Francisco CA 94114
fax 415-552-4565

Yes I agree, and my ID doc ordered the test, I don't have the results yet, it seems to take a while to get genotype results, but yeah, knowing this at the beginning of the infection allows monitoring changes from the start.

And one more vial, one more :)


I tested POZ in the fall... but strange enough my viral load is only 108 and cd 890.... i never seemed to experience the high viral loads and drops in cd... but my ? is do you have to have a viral load >1000 to have the genotype test?  My doc said that you did.... or can i request one now?

Yes, you do need a VL of about 1000 to get a reliable genotype test.  Having said that, the fact that your viral load is staying in the low 100s without treatment is very good news, even if you cannot get a genotype test.

Hi there for your information i tested positive 9 years ago, and viral load always between 50 and 240 so <1000 and CD between 500 and 900 and without treatment , never had the right of a Genotype test , and so what i am full of energy and never sick, of yes i forgot , the flu every 2 years and a cold every year like any other human being. I also forgot to say you should never consider starting any cure with these kind of figures if you are healthy don' t even think about taking the drugs. I have seen people around me being healthy and starting the medication and being sick from them all the time.
I guess we can call you HIV controler.  CD8 not infected  killing the CD4 cells being infected by the virus, forbiding the virus to replicate through your immune system.
Keep it that way.


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