Can mutations disappear?

[Buckster2005]

I had a genotype done recently that showed I was resistant to the 2 PI's I was taking but not the Viread.  The most recent genotype showed no resistance to any of the NNRTI's.  The Dr. put me on Atripla but I told him that since I took viramune many years ago that it probably won't work.  I also took sustiva but only for about 3 months 7 years ago and failed miserably but I also see I was resistant to the zerit and 3tc at the time.  I found a genotype he did from 7 years ago after taking the viramune and before the sustiva and it showed that I had the Y181C mutation but it doesn't show up on the latest one.  He said to trust him and not to worry.  Can the resistance disappear completely or is it still lurking somewhere?  I have a feeling it is the latter.  Thanks for any help.

[Cliff]

I think you should get a second opinion.  I was under the impression that resistance is permanent.  Once you were resistant to a drug, you would always be resistant to it.  If you have taken a drug previously and became resistant to it (years ago), then the resistance is archived.  The problem is that there just isn't enough of the resistant virus circulating in your system to get picked up by the test.

Read this response to a similar issue and take a copy of it to your doctor.

http://www.thebody.com/step/summer01/jeff.html

[newt]

With NNRTIs, the latter, most times

 -matt

[J.R.E.]

Hello,


Good question. I was reading something, ( and not that long ago. something to the effect that two unlike mutations can possibly cancel out, a particular mutation. I wish i had saved the article, because I wanted to ask more about it. Matt, did you read anything to that effect. It may have been in MEDPAGE today or MEDSCAPE. ( Not sure where. )

Hiv worker, any comments, on the original posters question.  THANKS


Take Care-------Ray

[gerry]

I would tend to agree about getting a second opinion.  It sounds like you have a pretty complicated resistance profile with your treatment history.  Like Cliff and Matt said, previously documented resistant genotypes do not disappear; they just fade into the background when the drug that selected for the resistant mutation is withdrawn.  When the same drug is introduced, the resistant mutants would tend to disappear.  You did not have the 103N that would have conferred high level resistance to all NNRTIs.  The 181C confers high level resistance to Viramune and low-level resistance to Sustiva.  Thus, there may still be susceptibility to Sustiva.  The problem is it's being paired with only one active NRTI (Viread) since you said you had resistance to 3TC, which means that you also have resistance to the Emtriva in Atripla (even though it's still a good idea to use Emtriva because it makes the Viread work better).  While the regimen might work for a while, it's likely that it would not be durable.  And if that happens, more resistant mutations would likely emerge and this would complicate your future options.

You may want to post your question to the Johns Hopkins website to find out what would be your best next regimen to take.  It would help to mention the specific mutations that you have from all the genotype tests you've had so far.

[Buckster2005]

Thanks everyone for all the insight. I kinda figured I am screwed.  I have scheduled blood work next week after one month on Atripla so I guess I will know more then.  My last VL was 35k and cd4 of 572 25%.  My worry was that I would blow the viread portion of this combo since it is about the only nrti I have left to use.  Diagnosed in 1986 I did what most people did with single meds as they came available.  I do still have 5 PI's I have never taken and show no resistance too but just nothing to mix it with.  I am only resistant to Viracept and Invirase in the PI catagory.  Although since the genotype showed resistance to the PI's and not the viread I guess that was the only one that was working to keep my VL where is was.