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Lack of resistance when initiated HAART- confused

Nov 16, 1999

I'm confused - if drug resistant virus can potentially develop and thrive when someone with an undetectable viral load skips a few doses, then how can HAART possibly be effective when it is initiated in the presence of a relatively high viral load? Why doesn't resistance always develop? I understand it can take *months* to initially achieve an undetectable viral load. Wouldn't this be the prime breeding ground for drug resistant virus?

Response from Dr. Holodniy

There is some background resistance, even in the absence of drugs. During the replication process, the HIV reverse transcriptase makes mistakes. These mistakes can result in copies that have genetic changes which result in drug resistance. There is little data to suggest that resistance is present or developing during the decline of viral load after starting therapy. MH

genotype sent and what to do while waiting for return
Genotypic vs. Phenotypic resistance

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