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Treatment Failure
May 24, 2003

DoctorYoung;

I would like to say I think what you all are doing here is very unique and so so very special. Please keep up the excellent work!

From What I've read so far, it seems that the meds only slow down HIV's progress to AIDS. If a person has just started treatments(mine happens to be Trizivir and Sustiva cd4 219/VL 5,000 started last month), how long will it take on average for a person to develop resistance to current treatments? Assuming one develops resistance, is there a point that subsequent treatments will also fail? If this is correct...does this mean that everyone with HIV will eventually succomb to AIDS (that is, if they don't pass away from something else)??

Many Many thanks and GOD bless.

Response from Dr. Young

Thank you for your question and kind words.

The rate of the appearance of drug resistance is dependent on a number of things-- first whether the virus is sensitive (susceptible) to the drugs that you're taking-- this is becoming more of an issue as more and more persons actually acquire someone else's drug resistant virus.

Assuming that your virus is drug susceptible, then adherence is much more important that which drugs you're taking- a well known study from Dr. Fischl in Miami looked a persons in prison who received their medications under directly supervised conditions (in jail, of course)-- all of them achieved and sustained undetectable viral loads after one year-- a rate far better than any clinical study. This study simply points out that the adherence to medications drives failure much more than the type of drugs used.

As for your drug regimen of Trizivir/efavirenz-- this should be a very potent regimen; more potent that one of the benchmark regimens of Combivir/efavirenz-- simply on the basis of the addition of abacavir to the regimen. There are many persons on one of these two regimens who have had virologic and immunologic success for years- over 5, or since the regimens have been available.

With that said, the average time to first treatment failure in the US is actually not very good, if one looks across the board to all patients, on all treatment regimens. The average time to first treatment failure in several population-based studies is far less than two yearss. This would say to me that there is much work to do in education and drug discovery to find regimens that are easier to take and are more forgiving, so to speak, with missed doses.

Overall, though, for the person recently starting on your first treatment combination- if you can find the ways to be as adherent as possible (as close to 100%), your prospects should be very, very good. Good enough, that I'd encourage you to continue to plan for the future-- retirement, getting old, etc.

Stay in close touch with your doctor about side effects, lab and clinic follow up monitoring. And above all else, be as adherent as possible. Good luck. BY



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