Hi Samuel-
a viral load of 85 copies is, in my opinion, nothing to worry about. The threshold to start thinking is over 200 copies. And realistically you won't be able to amplify any resistance on a genosure at 85 copies as it needs 400 copies. Remember resistance is a breakthrough occurrence due to suboptimal drug levels on virus, thus the dominant virus has the mutated species. At 85 copies it's hard to really quantify since this can also be what is called a "blip" which are viral loads under 200 copies and then go back to undetectable.
if you ran a genosure archive I would be really cautious with how you interpret that test as it is specifically for people who are NOT failing to see in the pro viral DNA what mitigations there are in general, not just in that moment of failure.
first thing I would do is make sure they are not taking any cations like mag or iron, like Maalox or tums. There actually is a small drug interaction and it should be kept in the forefront to remind patients of this (package insert has all the time requirements or food requirements) . Second, I would do counseling on adherence, which I think many people have gotten away from because they see the undetectable VL and think that is enough, but counseling on adherence, dosing etc is really good to do. 3rd just recheck the viral load. No need to jump to an expensive test when it's not warranted.
Angela
------------------------------
Angela Kapalko
Physician Assistant Chairperson for AAHIVM
Philadelphia FIGHT CommunityHealth Centers
Philadelphia PA
akapalko@fight.org------------------------------
Original Message:
Sent: 06-04-2021 19:34
From: Samuel Samalin
Subject: Is this Resistance?
I have a patient diagnosed and put on Bic 9 months ago. He takes his meds daily. His VL went from UD to 85 recently. I ordered resistance and genotype for Integrase etc.
Am I overreacting? If it is resistance, can I handle the analysis and response from my Primary Care clinic, or will I have to seek a higher level of
care? The patient has no other medical conditions or medications. Is there a blood level testing for Bic? Is VL 85 after 9 months of treatment a sure sign of resistance? He has been UD until a few months ago. He has not been ill or had any complications from ARV.
------------------------------
Samuel Samalin
Los Angeles CA
------------------------------