No genotype testing?

[Common_ground]

Asked my doc today about genotype and phenotype test, he told me that
If I dont reach UD or starting to show resistance a test would be done. My ID doc
is trained in the US and specialize in HIV. I go to a private hospital which is at the top end and of high international standard.  He is very knowledgeable overall in the field so I trust him but would like a second opinion from you guys.

Im in a country were hiv prevalence is rather high but treatment not yet so widespread, but I am lucky to have access to meds found in EU/US.

[buginme2]

US treatment guidelines call for a genotype test upon testing HIV positive regardless if treatment is initiated.

The following tests should be done upon testing positive:

"• HIV antibody testing (if prior documentation is not available or if HIV RNA is below the assay’s limit of detection) (AI);
• CD4 T-cell count (AI);
• Plasma HIV RNA (viral load) (AI);
• Complete blood count, chemistry profile, transaminase levels, blood urea nitrogen (BUN) and creatinine, urinalysis, and serologies for hepatitis A, B, and C viruses (AIII);
• Fasting blood glucose and serum lipids (AIII); and
• Genotypic resistance testing at entry into care, regardless of whether ART will be initiated immediately (AIII). For patients who have HIV RNA levels <500–1,000 copies/mL, amplification of virus for resistance testing may not always be successful (BII).

The entire US guidelines can be found here :
http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

[Common_ground]

I did all the other tests listed, he also knew genotyping was listed in the US guidelines but still didnt insist. Dont really know what to belive....

[Valmont]

Are these tests available in your country?

I´m actually living in Ecuador and these resistance tests are not done despite my doc knows about them for two reasons:  there are not available in the country and are terribly expensive for National Program.

I decided to do them by my own, here a lab take the sample and send it to US, this costes USD 870 and not covered !!!  But it is so important and avoid to waste time this meds that are known for not working on you (well I hope in my case this won´t appear, if sustiva don´t work, a month of Isentress is around USD 800 a month with "friend prices" directly with Merck...  We don´t have access to generic in a paralel market like in other country).  It seems it is the first time my doc is doing it in Ecuador...

Common, if you have an insurance that pay for it and can do one, do it...  It is possible to froze the sample and send it outside...  You have to know that a minimun VL is requered for doing it (10.000 in my case is asked), if you start treatment, you may not be able to make that test...  Nevertheless, the results can change in time because of virus mutations...

[Common_ground]

My VL was very low, around 2000 and I decided to start meds upon diagnosis.
 Im already 2 weeks in so to get a genotype test at this point would be hard, hopefully im UD by now and if not when I go check cd4 and VL in a month I will demand a genotype test. Or any other ideas?

I really wanted to take action early, adherence and supply of meds wasnt of any concern and It gave me the creeps knowing I was walking around with a fatal virus in my body doing nothing...

[Common_ground]

Valmont, yes I can do genotype testing here in this country.

[newt]

I'd insist on a genotype. You can do one on any stored blood sample taken prior to starting treatment.

Now you've started treatment it is perhaps a moot point whether it has current clinical value if you reach and maintain a undetectable viral load, but it may be useful in the future.

- matt

[Valmont]

Valmont, yes I can do genotype testing here in this country.

Good, so just do it !!!