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Drug Resistance
Sep 3, 2007

Thanks again, I love reading all of the other people's question as it continues to educate me and give me the tools to ask my doctor the right questions. My questions is, outside of not taking your medications properly, are there other factors one can control to prevent drug resistance. I am currently taking Atripla and havng a great responce, but drug resistance is a fear that I can not seem to shake. Obviously, I want to beable to take atripla for as long as possible, my entire life with out complications. Is this an unrealistic dream? Thanks again for everything you guys!

Response from Dr. Wohl

Besides suboptimal adherence, major risks for virologic failure of the medications include pre-existing resistance (that is, having acquired virus that is resistant to the meds being used), drug interactions that reduce the level of the HIV medications in the body, combinations of drugs that are not sufficiently potent to control the virus and, lastly, time.

It is likely that even with the best regimens we have today over an extended period of time one particular combination will not be able to keep the virus suppressed indefinitely. We have some data that older HIV regimens can keep the rate of viral replication low for years in some people but can these or newer regimens keep the viral level below detectable (also a moving target) for decades? Even when the viral load is "undetectable" there can be some viral replication and over time mutations can develop or be selected for that can lead to viral escape. The good news is that there are an ever increasing array of second and thrid and beyond regimens.

The goal should be to ride the wave of each regimen for as long and as far as possible. Taking the meds appropropriately and having good medical advice should keep these rides long.


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