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Resistance study findings
Jan 22, 2002

I am wondering what the panel make of the latest results showing that 3/4 patients on HAART have resistance to at least one drug. Do these show that HAART is not going to work as well in the future as hoped or is there some explanation such as poor adherence which accounts for them?

I felt very concerned when I read of the study.

Thanks for your opinion.

Response from Dr. Little

I share your concern about these study results. While the study did not specifically address treatment adherence, many previous studies have shown that this is a major problem and the source of much drug resistance. I would also expect however, that much of this resistance (among chronically infected patients) was the result of what we call - sequential monotherapy. That is, many people who were diagnosed with HIV infection in the late 1980's and early 1990's were treated with what was then - the best available therapy. This therapy was typically single drug (ie monotherapy) or dual therapy (two drugs) which were insufficient to complete prevent/suppress viral replication. What followed was an absolutely predictable development of drug resistance. Based upon what we have learned from clinical trials done during this time - we have now changed our approach to therapy. We also have much more potent drugs available to treat HIV infection. Unfortunately, these individuals, on the basis of their now pre-existing resitance do not respond as well to the potent therapies, because they have fewer treatment options with which to build a potent regimen (despite have had complete compliance with every regimen they were ever treated with!).

So in answer to your question, I think that non-compliance plays a big role - I also think there are many people with pre-exisiting resistance as a direct result from their early treatment (now considered suboptimal therapy).

In terms of what this means for the future - I don't think we know yet, but I would personally be surprised if we (as a Nation) will have more trouble finding regimens that will completely suppress many treatment-experienced and inexperienced individuals on the basis of significant drug resistance. The bottom line - this is not a good thing and we cannot ignore the fact that the face of this epidemic is changing again toward a more drug resistant future.



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