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

Resistance In The HIV Envelope?

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FiercenBed:
i dont usually get alota replies when i ask complicated questions <cept for newt who gives it a stab; god bless him> but here it goes.

with out retyping the entire history which is available on former post im on my 5th doc. i went to new york for evaluation in a clinical trial but was rejected because of having ks <i cant get a break>. but i did get a through examination <more then current doc> and a free cd4 and vl so it was worth the trip.

anyway @ issue is im in viro failure 1st regime 7 months kaletra & truvada. iv got 2 virtual phenotypes that say no resistance no mutations. iv got 4 docs that say 'i dont know y u wont suppress'. real brain trust here.

so once again i ask the medical director of the program the same tired ol song y wont i suppress w/ no resistance and complete adherence? for some reason i also have low absorption. hez stated that his opinion is that i am resistant to the medication. that the resistance is 'hidding in the HIV envelope' which is not dectalable by geno or phenotypes. it is very rare but he has seen it on occasions. <well im @ least not the only one on the planet> he continues to state that geno and pheno test are not always reliable and 'only give a snap shot' of the situation.

the four other docs act like these test are like a bible for hiv treatment. they should b for what they cost.

anyway herez the question......what the helll is the hiv envelop? iv googled it and it comes back w/ very specific medical gibble goo. none of the other 4 docs have mentioned this. if anyone has heard of this or has a link that is written in understandable english it would b appreciated! i guess on to doc #6.  thanx.
 

newt:
HIV is made up of several genes, quite a short list really, one of which is called ENV for "envelope".

Wiki entry on HIV genome with handy picture

Most commercial resistance tests don't really look at this gene, they look at mutations affecting reverse transcriptase and protease, the two enzymes most current meds (and all of your meds) are designed to act on.

Some research suggests that mutations in the ENV gene affect resistance, the ability of the virus to reproduce etc etc. ENV is a precursor to gp120 and gp41, two important proteins which enable the virus to attach to and fuse with target cells. Much of the research on the importance of ENV, gp120 and gp41 comes from study of fusion inhibitors.  So the science is fairly new, but reasonably well understood by very expert people and some smart docs.

Suggestion: if your drug absorption is okay, referral to a research centre where they can do sophisticted viral analysis, eg British Columbia, Stanford, Mayo etc.  Or rather, send your blood there. If not okay, get this sorted first.

- matt

FiercenBed:
i shoulda known....lol. i was just gonna send ya a pm but thought that was intrusive. jeesh is this stuff fucked up or what! i dont know what the repercussions r yet, but itz nice to have a direction to go in and as i said that im not the only person on the planet w/this problem.

itz gonna be an interesting conversation w/ my doc on this one. letz c how much the man knows.

bimazek:
http://www.roche-hiv.com/roche-in-hiv/Resistance.cfm?link=Resistance

check out this detailed
roche

resistance

somethings i got from it are... perhaps the drug is not being absorbed, can a person tolerate higher doses, or new combos

HIVworker:
I don't get this. How can resistance to these two drugs be in the envelope? I've seen mutations in the cytoplasmic tail that speed up the fusion process because the virus lacks any communication with the capsid (supposed to slow things down) but nothing I have seen affects resistance to RT inhibitors.

There are resistance tests available for the Env. Labcorp has one http://www.labcorp.com/services/hcp/hiv/index.html. I'd be surprised if nobody offered a Env genotype or phenotype test given that you get T-20 resistance mutations in Env. If they are not widely available they will be soon as maraviroc is coming on line.

I studied Env proteins for 5 years. If I can help out, let me know.

Rich

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