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Resistance Inevitable?
Jun 4, 2006

Hi Dr. Young,

Thanks so much for taking time to answer so many questions even in the midst of what I'm sure is a super busy schedule. My question is in regard to resistance. I have read over and over again that you believe suppression of the virus is certainly possible for a long time...perhaps a lifetime. The only thing that scares me is the idea that resistance seems to occur in everybody at one point or another, those with the regular strain of HIV or with one that harbors a number of mutations. As much as I want to believe that you are correct that normal life expectencies are a very real possibility, almost all the posts I read have to do with switching medications, many bc resistance to certain regimens is alrady taking place. Although I know that first-line regimens can be very potent, it seems like many people, with luck, get to the 10 year mark with them and then have to switch to a second line regimen due to resistance issues (I've read that some of your patients are still on their first regimens, but I assume they are not the majority). The thing is, what happens if the second line regimen is only good for another 10 years or so maximum? Then where do we go from there? I understand that really awesome drugs are being developed to combat resistant strains of the virus, and I've read that everytime a resistant strain of the virus emerges, it loses something in the process...like the ability to replicate as well as it did before and, thus, it's overall ability to infect healthy cells. Is this true? If so, does this mean that suppressing a mutated, resistant form of the virus is somewhat easier than the initial strain of the virus? Are "third line regimens, so to speak, available or being developed? Or are they simply considered salvage regimens? I'm sorry to sound so negative..I just keep reading the posts, adding up numbers, and all I can think of is resistance in 20 years' time. I know I should be focusing on the "now" of my life...it's just so hard to right now. I sincerely believe in your expertise and if you say that most people living with HIV with access to good medical care can plan for a normal life, then I believe you are correct. I suppose I would just like to feel that things are not eventually headed for the worst, despite all the incredible efforts of scientists and physicians like you and the other board members here. Thanks so much for your help. You offer so much hope in the face of very difficult circumstances.

Matt

Response from Dr. Young

Thanks for your post and kind words.

Resistance to HIV medications is quite common and can really complicate treatment. Resistance, in my humble opinion, need not be inevitable-- so long as sufficiently potent medications are chosen and the medications taken with optimal adherence.

As we get further along with HIV drug discovery, second and even third line treatments can become very potent and tolerable; though it's still reasonable to assert that the first-line regimens are the best opportunity for potency with ease dosing and side effects.

No one can accurately predict 20 years in the future, but my hunch is that the vast majority of my patients will be around at that time to see what the future does deliver- it's my hope and expectation that we'll continue to think of HIV as a manageable disease and that the major cause of death among HIV-infected patients will be diseases other than HIV itself.

Thanks for reading-- drop us a line here anytime. BY



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