Biktavry Resistance

[divao]

Hi.I am
From turkey. I've been on treatment for 1 year and I'm using biktarvy. I have something to wonder about.does anyone resistance to biktavry ? if biktarvy is resistant what drug can we use

[Jim Allen]

Hiya,

Welcome to the forum. Understand you have been taking Biktarvy for a year. (Bictegravir/emtricitabine/tenofovir alafenamide)

Is the viral load suppressed, and how are you otherwise doing with this treatment?

Why the concern about resistance, and would that be regarding Bictegravir as part of the treatment? Anyhow plenty of other combinations, although it would depend on what the resistance profile looks like and other medical needs if any. 

[divao]

yes viral load suppressed. i'm not good at english sorry.
viral load
26 august 471,000
11 october drug start
11 november 198
10 february 55
4 august 210
After the last test, the fear of resistance started, if such a situation happens, will things get very difficult for me?

[Jim Allen]

Hiya,

Your English is fine, I barely manage English myself, and as for the results, they are good.  Within a month of starting treatment, the VL dropped 98%+

What has your doctor said about the more recent results and have they mentioned changing medication? Did they test for resistance?

You are within the first year of starting treatment, and, the recent 210 isn't concerning, although given you have never been below 50 and it's been just under a year prehaps, it's something to keep an eye on and consider other treatment options with your doctor.

However, resistance as such would not be something I would worry about with these results.

[Jim Allen]

So forgetting lab results, how are you feeling/doing otherwise?

[divao]

actually I'm fine. I haven't been sick for the last 1 year. My weight and energy are good. My CD4 result is always 1000+ but I've never been negative. My doctor wants a new test and I will give blood again. I love biktavry it's easy to use

[Jim Allen]

wow, 1000+...

Be careful 80% of us here will want to steal them from you  if we could

Anyhow, sounds like your doctor is doing the right thing by reordering the blood work, as sometimes it can be a false result or simply defective HIV copies being counted.

However, long story short, should your next results show a higher VL again, plenty of HIV treatment combinations are possible. Now I admit I don't know what treatments are available where you live, but if you do need to change treatment, then in the best-case scenario, you switch to another once-a-day pill option or prehaps, worst-case scenario 2-3 pills a day.

It's not the end of the world, so try not to stress about it. 

actually I'm fine. I haven't been sick for the last 1 year. My weight and energy are good.

Happy days and I mean it as feeling okay is great and its really important

[divao]

I haven't seen any side effects from biktavry and this made me happy. Actually, I have to say that before the test, there was often alcohol, drugs and nightlife for 1-2 weeks, maybe these affected the last test. Also, HIV treatment opportunities are good in my country, all treatments and drugs are free.and yes despite everything cd4 1000+ i guess i'm lucky in that 

[Jim Allen]

Also, HIV treatment opportunities are good in my country, all treatments and drugs are free.and yes despite everything cd4 1000+ i guess i'm lucky in that 

So same here in Ireland, its free or at least no cost to the person needing treatment.

I haven't seen any side effects from biktavry and this made me happy. Actually, I have to say that before the test, there was often alcohol, drugs and nightlife for 1-2 weeks, maybe these affected the last test.

Well, wait and see what the next results are.

I do fully understand that you might be nervous about the idea of switching medication if the current treatment is easy for you but the next treatment combination might be just as easy and at some stage, we all have or will switch treatments.

Keep us posted but whatever the outcome I suspect you will be okay.

alcohol, drugs and nightlife for 1-2 weeks

All that but no Rock & Roll?

Look, bit of fun is good but don't overdo it.

[Jim Allen]

Anyhow, I am putting the kids to bed, so I suspect I will not be replying to you again today, but I wish you well and keep us posted.

[divao]

Thank you for your answers. I will let you know about my new results. I still believe there will be good results

[leatherman]

Viral load (and cd4 counts) does not always steadily go up or down. As the HIV meds works, sometimes your VL can "bounce around" on the way to undetectable.

26 august 471,000
----You meds certainly worked; quickly and dramatically reducing your viral load
11 november 198
10 february 55
4 august 210
----as you are getting closer to undetectable, your viral load is bouncing around just a bit instead of steadily decreasing. But if definitely been decreasing, so that's great news.

also take note that a VL <200 is considered "successful treatment" and not everyone gets to undetectable quickly. Matter of fact, a few people never or rarely reach undetectable and can't stay undetectable. It's not a common problem but it doesn't make it wrong or your fault if you can't reach a complete undetectable. Your VL, mostly <200 and with no side effects or other illnesses, means you shouldn't worry.

as to resistance, that happens when you improperly take your medications. If you take meds for several days and then skip several days, that's when resistance might happen. Daily meds keep the amount of meds in your system level. If you were taking meds for a few days in a row but then skipped a few days, the took them a few days and then skipped days, the level of meds in your system would drop very low before coming back up to normal. This might allow HIV to become resistance to those meds. Resistance does not happen if you take your meds every day.

hope that helps. just give it some time and see what happens with your next test results.

[divao]

Your answer put me at ease, thank you very much. You are all very nice people

[leatherman]

it's always worrisome in the early years after getting an intense diagnosis. think about how much people worry when they get a cancer diagnosis? think about how long people worry about cancer after getting treatment and being cured or going into remission?

Because I was diagnosed with HIV late and years ago when the medications weren't so good, I was sick for a long time. But the meds greatly improved and I got better. However, I did spend a long time after that worrying about if I would get sick again. But not anymore 

These days, if your Viral load is <200, your cd4s are >200, and you take your meds everyday, there really isn't a reason to worry about HIV issues. Instead, worry about getting older and what diseases you might get through your family genetics.

[divao]

yes, I am just learning and my worries are slowly decreasing. The information you have given is very valuable.

[divao]

I gave blood today and now I have a new doctor. He is a very good doctor. I will share my test results with you. I have a question. Anti HIV test was done in my old control and it looks negative. Why was this test done again?

[Jim Allen]

Seems to be an Elisa from Feb 2022 without a value. 

To be honest, most of that report felt a bit vague. Anyhow, no idea why it was run, definitely no need for it; ask the doctor when you next speak to them if you are concerned, but I see no reason to worry.

I've had a similar issue with other lab tests being run when they are not needed. I asked why they keep doing it, and it was a shoulder shrug. Seems to be just a habit and tickbox exercise. I've also had lab reports come up in my file that wasn't from me, thankfully more rare and not at the hospital but GP, including a pregnancy back in 2000   

[Jim Allen]

I gave blood today and now I have a new doctor. He is a very good doctor.

  Glad to hear you feel comfortable with your new doctor, definitely helps make things easier.

[divao]

my doctor said that RNA values ​​can fluctuate like you and there is nothing to worry about, he told me we can change drugs if necessary.

[Jim Allen]

my doctor said that RNA values ​​can fluctuate like you and there is nothing to worry about, he told me we can change drugs if necessary.

Yeah, tad simplistic, but sure.

In the first year of treatment, micro blips happen. Also, defective copies can be released from the reservoir and counted incorrectly in the VL.

Your results so far are great; nothing to stress about. 

[divao]

hello friends.the result is here.
hiv pcr negative 681 ui. what does that mean?

[divao]

i talked to my doctor today.rna 680.resistance test will be done.cd4 1660

[Jim Allen]

Hiya,

What makes more sense is if the result was a detectable viral load and hence the resistance testing. Otherwise, they would not be running a resistance test or have anything to run it with.

No need to panic, though; it seems like your new doctor is on top of this, and prehaps a tweek in your treatment will be the outcome, and that's fine.