Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Resistant or Still Irresistable ??

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OK, my last three lab results have been not so great,

at 90 day intervals they have been
* vl<400. cd4 326  24%
vl 785 cd4 584  22%
vl 589  cd4 416 31%
vl 1310 cd4 502 25% 
Aparently my doc thinks that Im either developing resistance or Have been resistant all along and managed to get two consecutive Undetectable results because at least some part of my combo is effective. ( Reyataz Epzicom Norvir)

Ive been 100% Adherent, although the time Ive taken the meds has varied by two or three hours per day. and Ive always taken them with food as reccomended. I also drink a bit too much at times, could that have screwed up the effectiveness?

Anyway, He's ordered an HIV Genotype next week so we'll soon get a snapshot of my little friend and the cards he's holding...Im ofcourse left with a few questions :

Is the idea of Part of the drug combo Being Effective enough to lower the  vl (<100 in one test ,<400 in the following one ) correct ? or is it an 'ALL or Nothing'  thing?

The above Combo is the first one Ive been on ( started 4-1-05) so I was 'Treatment Naive" . From what Ive been reading its not likely that I developed resistance this quickly so Im guessing that Ive been resistant all along OR that Im just taking longer to get to a truly undetectable  level <50  since my 'undetectable' results were from the  Crappy less sensitive test that only measured down to 400,

So, in a Nutshell, My Questions are : 1) first of all how long will the Genotype test take- I have a follow up apointment two weeks after the blood draw since theyre also checking Hep B antibodies, and Liver Function after starting  Statin a few weeks ago. I dont want to have my hopes up for the Genotype results if theyre going to take longer...
2) If I'm NOT resistant to anything then WTF ? why isnt it Undetectable after 15 months of HAART and perfect Adherance?  as well as plenty of Supliments and a very health conscious diet.
3) If I AM resistant to a class of drugs, will he be able to use the Geno. Test to 'Custom design' a Combo that will RELIABLY knock the vl to Undetectable and get the cd4's going in the right direction again? or will it still be a crapshoot to some degree ? 

OH ya, as long as were on the topic of Resistance & Mutation, I saw one of my favorite Old Sci Fi Movies Lately "The Andromeda Strain" about a constantly mutating Alien Virus. Believe me It was a whole different experience watching it since my Diagnosis... Eventually the virus mutates to a non lethal form and the world is safe. YAY !
I was just wondering, Why cant HIV eventually muate to something either Harmless or Easily Killed ? If my Virus has mutated into a Drug resistant strain, why cant it mutate again into something suceptable ?  Just one for you science whizzes out there ?

Any Help would be great ,
     L 8)

Hey hello Mr Wood...

I sincerely hope your doc's slightly slack attitude to IMEMDIATE RETEST of viral load after a result above the previous one and above undetectable has not reduced your treatment options.... smack on the hand with a ruler please...  but no matter...

The most likely mutation to have developed is the nuke mutation M184V.  This is the most common mutation to develop on combos that do not completely suppress the virus containing 3TC.  This is perfectly managable by a switch to a Viread or AZT containing combo, both of which are extra effective against M184V strains. 

HOWEVER, lets see the test results, which I trust will be back in 5-10 days.

PI wise it is unlikely you have developed a serious PI resistance.  If you have and it's the signature one for Reyataz then other PIs may well be more effective against the mutated virus.  A bump onto, say, Kaletra may be enough to do the dirty and get you to <50.

If resistance is detected, it is more likely that drug pressure has brought some undetected mutant strain to the fore. 

If no nuke resistance is detected ... one other point to consider is timing and Epzicom 1 x day.  Really you need to be strict about this, cos it's not so forgiving on timing.  A switch to Ziagen + 3TC (or FTC) 2 x day may in fact improve things and effect an undetectable viral load.  Also in this IF... boosting the Reyataz with an extra 100mg of norvir or indeed doing this and upping the Reyataz to 400mg/day may also be in the armoury here (cos some people just don't get a high enough level of Reyataz - there's a study on this and if you want the link I'll hunt it out). 

Otherwise it's prob a switch to a stronger PI (Kaletra, TMC-114 etc) or an NNRTI  maybe + a perhaps a new mix of nukes. IF IT'S A SWITCH BECAUSE OF RESISTANCE... do think about changing as many drugs as possible, rather than just one.

But, I wouldn't fret.  Unless some lurking horror strain is uncovered the management of this situation should be relatively straightforward. There is no scope for slackness though, timely intervention saves lives and use of T-20 etc etc.

- matt

Thanks Newt !!   Thats exactly thy info that I was looking for. :-*
I was told from the beginning that I had a good bit of leeway as to when I took the meds each day, so I was never very strict about it. However since the last labs , Ive tightened up on it considerablly, and after your mention of Epzicom and its 'unforgiveness'...  I'll  time it within an hour each day ,will it eliminate THAT variable.?.

MY big fear  is that Ill have to switch to a combo that wont be as kind as my present one in terms of side effects, but Ill deal with that as it comes.  Ill definitely have my notes handy for the next visit with the Doc,  This also brings to light a concern Ive had lately with the random selection of Doctors that have been seeing me at the Clinic. Rarely the same one twice in a row so its no wonder that theres been some 'Slack' in the treatment...
Thats definitely going to change...

Thanks Again,
Hope youre keeping Cool in London..

Good luck

I am in Brighton, n it's boxers only temp indoors even though it's 10pm ( ;))

I had blood drawn for the HIV genotype test ( and others) on the 1st, and a follow up on the 15th for the results so hopefully the genotype will be among them... Just out of curiosity  what will it look like ? a list of codes and letters that I wont be able to understand? a written letter from the lab ? or something that looks similar to my regular lab results ?? I'm sure theyll make a copy for me so Ill be anxious to 'translate' it and see for myself   is there anything I can read up on in the meantime ???  Is there any chance that Ill get a picture the actual DNA ? it wouldnt be as cool as say, an ultrasound of a baby, but it sure would be close. 8)


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