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numbers, numbers
Apr 17, 2003

hi, I'm newly infected/diagnosed and am pretty scared right now. I've been trying to educate myself as much as possible. And sites like this are very helpful. But I'm really afraid of three things. 1)med's side effects. 2) O.I's 3)drug resistance. You read all about these things on this and other sites but never is it quantified how often they occur. For instance do 10 of people develope drug resistance or 75, or 100? Do 50 of people develope side effects to meds or just 5? How long can one specific regimen usually work befoe it fails? And how much does adherence affect the failure rate. Thanks for your help

Response from Dr. Young

thanks for your question and sorry to hear of your situation.

In general, most persons with HIV infection in the US do fine for many years, even without the initiation of antiretroviral therapy.

Once therapy is started, I believe that key issues are finding an experienced caregiver, finding the right medications and lastly, monitoring and adherence to therapy.

Newer medications or improved insight into management of treatments can reduce or eliminate the side effects.

Careful monitoring and appropriate initiation of treatments (before CD4 counts decline too much) can almost always eliminate the risk of having an opportunistic infection, and for those with CD4 counts below 200 (where there is risk of OIs) improve immune function so that OIs don't occur.

Drug resistance is, and will continue to be a real nagging issue-- there are increasing numbers of persons who are initially infected with drug resistant virus-- these persons essentially have to have their first antiretroviral regimen be a second- or salvage-regimen. For the large majority of persons who have acquired wild type (drug sensitive) virus, the essential way to prevent drug resistance from occuring is to find the best, well tolerated drug regimen and do everthing possible to avoid missing doses. In our clinic, the most adherent patients typically stay on their first regimens for many years, and have little risk of developing significant drug resistance. For those who find adherence more difficult, the risk of treatment failure and drug resistance is very real-- failure of first regimens after less than a year are not uncommon. Differences in drug failure can be measured with only a 5% difference in adherence.

So the answer for you really depends on how well your treatments were selected, adherence, and a bit of good luck.

Good luck. BY



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