Mechanism of resistance? How does it work
Aug 29, 2010
Good day Dr.Young;
Had a question regarding the all important drug resistance issue.
How likely is it to develop resistance assuming one does not miss a single dose and takes all doses within an hour or so of the prescribed time...(perfect adherance)? Is adherance also a measure of the body's ability to absorb the medication?
I mean what if one takes every dose, what guarantee is there that the body will absorb every dose taken? Can that not affect adherence negatively?
Response from Dr. Young
Hello BRHIVer and thanks for your post.
HIV drug resistance emerges when the HIV drug levels are insufficiently potent-- either because of the wrong drug selected (failure to recognize baseline resistance) or sufficiently imperfect adherence to dosing (or other dietary or drug interaction restrictions).
Most current treatments are quite "forgiving" with regard to the timing of dosing- meaning that an hour (or two or three or four) timing won't affect the effectiveness of treatment.
As for adherence, this is indirectly also measured by absorption-- for example atazanavir (Reyataz) should be taken with food, to increase absorption to adequate levels. Adherence means many other things too-- avoiding missing doses, not missing follow up clinic appointments, etc.
The best insurance to having your medications work is (of course) to take them and get routine and periodic (every 3-4 month) clinic and laboratory monitoring. Make sure to ask questions and let your healthcare team know about your symptoms, medications that your taking (or not, as it were)-- this includes supplements, over the counter remedies, etc. These strategies should allow for improvements in medication taking and avoidance of any unwanted problems or interactions.
I hope this is enlightening, BY
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