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Resistance now or later
Feb 6, 2005

If one of the goals of treatment is to keep the VL low and prevent mutations and resistance, doesn't it make since that treatment should be started as soon as possible after HIV infection to lessen the changes of virus mutation?

Response from Dr. Young

Thanks for your post.

Drug resistance is a major factor in the long-term success of HIV treatments and one of the primary reasons why treatments fail. What's important to bear in mind is that drug resistance doesn't occur unless there are drugs (antiretroviral medications) in the body. If one starts on treatment early, then you (and HIV) are more likely to be exposed to medications and therefore have an increased risk of developing drug resistance, not less risk.

There is an excellent study from investigators from the University of British Columbia (published this month in the journal, Clinical Infectious Diseases) that shows that the risk of drug resistance is related to adherence, but significantly, even among those persons with very good adherence, there is risk of resistance.

If treatments are sufficiently potent and are taken with near-religious adherence, the risk of drug resistance and treatment failure is very low. Hence, resistance shouldn't deter people from taking medications when needed, but should be yet another reason to find the best tolerated treatments with the best possible adherence.

Thanks for reading. BY



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