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Author Topic: Get a genotype (resistance) test when you first test positive  (Read 5273 times)

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Offline allanq

  • Member
  • Posts: 689
  • still life with pills
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
415-863-3366
fax 415-552-4565
Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline milker

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  • Posts: 4,034
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Re: Get a genotype (resistance) test when you first test positive
« Reply #1 on: March 24, 2007, 11:48:07 AM »
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 :)

Milker.
mid-dec: stupid ass
mid-jan: seroconversion
mid-feb: poz
mar 07: cd4 432 (35%) vl 54000
may 07: cd4 399 (28%) vl 27760
jul 07: cd4 403 (26%) vl 99241
oct 07: cd4 353 (24%) vl 29993
jan 08: cd4 332 (26%) vl 33308
mar 08: cd4 392 (23%) vl 75548
jun 08: cd4 325 (27%) vl 45880
oct 08: cd4 197 (20%) vl 154000 <== aids diagnosis
nov 2 08 start Atripla
nov 30 08: cd4 478 (23%) vl 1880 !!!!!!!!!!!!!!!!!!!!!!!!!!
feb 19 09: cd4 398 (24%) vl 430 getting there!
apr 23 09: cd4 604 (29%) vl 50 woohoo :D :D
jul 30 09: cd4 512 (29%) vl undetectable :D :D
may 27 10: cd4 655 (32%) vl undetectable :D :D

Now accepting applications from blowjob ninjas™

Offline Ricky

  • Member
  • Posts: 6
Re: Get a genotype (resistance) test when you first test positive
« Reply #2 on: April 13, 2007, 05:37:49 PM »
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?

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Get a genotype (resistance) test when you first test positive
« Reply #3 on: April 13, 2007, 09:41:50 PM »
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.

Offline heracles

  • member
  • Posts: 1
Re: Get a genotype (resistance) test when you first test positive
« Reply #4 on: April 19, 2007, 07:51:49 AM »
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.

Offline J.R.E.

  • Member
  • Posts: 7,159
  • Joined Dec-2003 Living positive, since 1985.
Re: Get a genotype (resistance) test when you first test positive
« Reply #5 on: April 19, 2007, 09:16:44 PM »
Hello,

Just to add to what the others have stated....This article was in the IAPAC ( International association of physicians in Aids care ) I picked this magazine up today in my doctors office.


RESISTANCE TESTING :

"Tests help doctors identify drug resistance and determine which antiretroviral drugs will be effective against a patients virus and which will not.

HIV treatment guidelines from the Department of Health and Human services recommend resistance testing for all recently diagnosed, or chronically infected treatment-naive patients BEFORE they begin HAART, as well as for patients whose antiretroviral regimens fail to achieve complete viral suppression---that is, a viral load usually less than 50 or 75 copies per milliliter ( or copies/ml of blood. )

Two basic types or testing are available. Genotypic, looks for specific viral mutations associated with drug resistance. It costs about $250.00 and generates results in about two weeks. Genotypic testing is used both for newly diagnosed patients and for those who experience a rise in viral load while on HAART

The other form of resistance testing is known as "phenotypic".  It can tell doctors how much of a particular drug will be required to suppress a drug-resistant virus.

Phenotypic testing is more expensive ( Approx $800.00) and can take two to four weeks to obtain the results, but it may provide additional benefit for people who have failed to respond adequately to multiple regimens."



-----Ray



 



Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline milker

  • Member
  • Posts: 4,034
  • Protected phone sex
Re: Get a genotype (resistance) test when you first test positive
« Reply #6 on: April 19, 2007, 10:07:15 PM »
So the HIV phenotypic transformation is harder to find because it could just be few amino-acids that changed place? I initially thought that phenotype was a faster exam?

Damn virus. I'll put my HIV on ebay.

Milker.
mid-dec: stupid ass
mid-jan: seroconversion
mid-feb: poz
mar 07: cd4 432 (35%) vl 54000
may 07: cd4 399 (28%) vl 27760
jul 07: cd4 403 (26%) vl 99241
oct 07: cd4 353 (24%) vl 29993
jan 08: cd4 332 (26%) vl 33308
mar 08: cd4 392 (23%) vl 75548
jun 08: cd4 325 (27%) vl 45880
oct 08: cd4 197 (20%) vl 154000 <== aids diagnosis
nov 2 08 start Atripla
nov 30 08: cd4 478 (23%) vl 1880 !!!!!!!!!!!!!!!!!!!!!!!!!!
feb 19 09: cd4 398 (24%) vl 430 getting there!
apr 23 09: cd4 604 (29%) vl 50 woohoo :D :D
jul 30 09: cd4 512 (29%) vl undetectable :D :D
may 27 10: cd4 655 (32%) vl undetectable :D :D

Now accepting applications from blowjob ninjas™

Offline J.R.E.

  • Member
  • Posts: 7,159
  • Joined Dec-2003 Living positive, since 1985.
Re: Get a genotype (resistance) test when you first test positive
« Reply #7 on: April 20, 2007, 03:38:55 PM »
Milker,

If you want to read more, on the post that I made above , click on the link below, You can download the issue of IAPAC :  PDF format pages 17-18

http://www.iapac.org/home.asp?pid=9276



Ray
« Last Edit: April 21, 2007, 03:39:02 AM by J.R.E. »
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline milker

  • Member
  • Posts: 4,034
  • Protected phone sex
Re: Get a genotype (resistance) test when you first test positive
« Reply #8 on: April 20, 2007, 03:52:17 PM »
Thank you J.R.E I have downloaded it :)

Milker.
mid-dec: stupid ass
mid-jan: seroconversion
mid-feb: poz
mar 07: cd4 432 (35%) vl 54000
may 07: cd4 399 (28%) vl 27760
jul 07: cd4 403 (26%) vl 99241
oct 07: cd4 353 (24%) vl 29993
jan 08: cd4 332 (26%) vl 33308
mar 08: cd4 392 (23%) vl 75548
jun 08: cd4 325 (27%) vl 45880
oct 08: cd4 197 (20%) vl 154000 <== aids diagnosis
nov 2 08 start Atripla
nov 30 08: cd4 478 (23%) vl 1880 !!!!!!!!!!!!!!!!!!!!!!!!!!
feb 19 09: cd4 398 (24%) vl 430 getting there!
apr 23 09: cd4 604 (29%) vl 50 woohoo :D :D
jul 30 09: cd4 512 (29%) vl undetectable :D :D
may 27 10: cd4 655 (32%) vl undetectable :D :D

Now accepting applications from blowjob ninjas™

Offline J.R.E.

  • Member
  • Posts: 7,159
  • Joined Dec-2003 Living positive, since 1985.
Re: Get a genotype (resistance) test when you first test positive
« Reply #9 on: April 20, 2007, 04:35:14 PM »
Thank you J.R.E I have downloaded it :)

Milker.

Another good article to read, in that download is titled :  "HAART TO HEART"


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline FiercenBed

  • Member
  • Posts: 183
Re: Get a genotype (resistance) test when you first test positive
« Reply #10 on: April 22, 2007, 01:58:55 PM »
BEWARE OF THE INSURANCE COMPANY!

check your benefits BEFORE they do a resistance test. the test cost $700. check out my BCBS Level II Apeal post for further info on coverage BCBS sez they wont pay for a resistance test on 'untreated hiv'.

ask them if ur covered for cpt code 87900 AND 87901. it takes 2 cpt codes to do one test. iv gotten to be an expert on this insurance bs. questions send me some mail.

good luck

Offline puertorico2006

  • Member
  • Posts: 957
Re: Get a genotype (resistance) test when you first test positive
« Reply #11 on: April 22, 2007, 03:36:59 PM »

Damn virus. I'll put my HIV on ebay.

Milker.

doubt youd get offered much for it  ;D
Infected Probably: may 2005
Diagnosed: 11/2006

11/28/2006 CD4:309 / VL: 1907 No meds yet
12/27/2006 CD4:339/  VL:1649 No meds yet
  4/28/2007 CD4:550/  VL:1800 No meds :-)

 


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