Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
August 22, 2014, 03:50:04 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 635681
  • Total Topics: 48228
  • Online Today: 238
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Blip or emerging resistance?  (Read 2249 times)

0 Members and 1 Guest are viewing this topic.

Offline BM

  • Member
  • Posts: 340
Blip or emerging resistance?
« on: May 12, 2011, 07:16:59 AM »
My friend recorded a viral load of 75 as part of his routine bloods about six weeks ago. His repeat viral load (taken a month after the first) was 174. What should he do here? Is this likely to be two blips or could he be developing resistance? I know a resistance test can't be carried out until the viral load is over 1000, but aren't more serious viral mutations likely to occur if one persists with a failing regimen?

My friend has been taking Atripla since 2008 and has been continuously undetectable since then; however, he doesn't great adherence in the sense that while he takes a tablet every day, it's not always at the same time (hours difference sometimes).

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Blip or emerging resistance?
« Reply #1 on: May 12, 2011, 07:24:08 AM »
Get another viral load test.

It is a less than an outside chance if he has been on Atripla since 2008, adherent and continuously undetectable that resistance is the issue.

A third test result that is 300-500+ is cause for concern, however.

"Blips" often mean short-term minor viremia, which shows up as extra HIV particles in the blood.

On older viral load tests a result under 100 is probably "undetectable". On the latest tests under 200 is probably so (they's more sensitive in an unhelpful way).

- matt
"The object is to be a well patient, not a good patient"

Offline BM

  • Member
  • Posts: 340
Re: Blip or emerging resistance?
« Reply #2 on: May 24, 2011, 05:04:49 PM »
He had another test yesterday. Interestingly, his doctor asked him to stop taking supplemental vitamin D in case it's affecting his meds. I thought this was very strange advice. Do you think there's anything to it?

Offline BM

  • Member
  • Posts: 340
Re: Blip or emerging resistance?
« Reply #3 on: June 07, 2011, 06:53:06 PM »
Third viral load test came back: 157. His doctor said just to wait it out till his next set of labs.

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Blip or emerging resistance?
« Reply #4 on: June 07, 2011, 06:57:10 PM »
Tend to agree, though not easy to live with. If it's up again next time action is called for.

- matt
"The object is to be a well patient, not a good patient"

Offline BM

  • Member
  • Posts: 340
Re: Blip or emerging resistance?
« Reply #5 on: November 18, 2011, 07:32:10 PM »
With a couple of subsequent viral loads in the 100s, my friend's doctor has taken him off Atripla and started him on Truvada and twice-a-day 600 mg darunavir with 100mg ritonavir (for the first fortnight while the efavirenz works its way out his system) to be followed by 800 mg darunavir with 100mg ritonavir once a day, for good.

It occurs to me that if my friend has developed resistance (a test was inconclusive), then he has been effectively been prescribed darunavir mono-therapy. Do you have any thoughts on this, newt?

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Blip or emerging resistance?
« Reply #6 on: November 21, 2011, 05:23:54 AM »
Newt thinks that if there is resistance it is most likely to be to efavirenz, not the other two drugs. I would be surprised if was not so. Therefore Truvada is still active. There are nerdy reasons for me thinking this which I am happy to go into, but it will probably bore the socks off you.

Anyway it might not a resistance issue, it might be one about how much of the drug gets absorbed. A fair few need more than the 600mg of efavirenz to get an effective drug level.

The new combination seems a good choice (indeed it is what I am on ) and forgiving on timing.

- matt
"The object is to be a well patient, not a good patient"

Offline BM

  • Member
  • Posts: 340
Re: Blip or emerging resistance?
« Reply #7 on: November 21, 2011, 07:42:53 PM »
Thanks for that, Matt (newt). I'd love to hear more about the reasons why it's more likely efavirenz has failed rather than either of the other two drugs.

BM (an unboreable, dyed-in-the-wool nerd)

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
Re: Blip or emerging resistance?
« Reply #8 on: November 23, 2011, 04:24:18 PM »
K103N is the grandmother of resistance-inducing mutations for efavirenz and nevirapine, and is often seen in cases where there appears to be no pre-treatment resistance to efavirenz etc but viral suppression is not achieved.

The theory is that the resistant strain was was probably acquired on initial infection but "archived" pre-treatment as other types of HIV predominated. Therefore the mutant strain eluded detection by routine resistance tests. The relevant environmental pressure, ie taking efavirenz, brough it to the surface. << there are papers on this, a very nice one looking at treatment failure in women in Africa

Tenofovir is extra effective against M184V mutant virus, and M184V is very frequently seen when K103N mutations show up treatment failure. M184V confers high level resistance to 3TC and FTC. In the case of Truvada it doesn't usually matter since the tenofovir in this nuke pair is able to attack the M184V virus with vigour. Hence Truvada still works.

Also, the K65R mutation* is needed to make tenofovir unworkable, and for some unknown reason this is rarely seen even in treatment failure when FTC is combined with tenofovir. Hence, Truvada still works (proof is in the viral load tests). This insight comes alas from unreleased Gilead data and I damn well wish they would publish it.

Therefore, I conclude, the chances are, if it is resistance not drug absorption, the most likely drug for which there is resistance is efavirenz. No-one can really say without decent results from a resistance test.

- matt


* Or a really serious bunch of other nuke-related mutations which almost certainly would have been detected pre-treatment, so I am ruling out in this case.
"The object is to be a well patient, not a good patient"

Offline BM

  • Member
  • Posts: 340
Re: Blip or emerging resistance?
« Reply #9 on: November 25, 2011, 10:24:52 AM »
Thanks Matt!

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.