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What should you do with multidrug resistant?

Aug 4, 2012

Hello Dr.Young,

I'm 40 yo male (CD4 360/20%,Vl <40), on arv for 2 years and currently with Isentress+Truvada I just met my HIV specialist last week and I asked him how long you will develop drug resistant even with 100% adherence. He said that is true there's always a possibility to develop resistant even with 100% adherence but is extremely low.

If let say someone develop resistant to all available regiments, what should you do? Stop your current regiment or better keep taking that?

Thank You

Response from Dr. Young

Hello and thanks for posting.

While there's "always a possibility" (there is too, the possibility that a meteor could fall from the sky), the likelihood of treatment failure leading to resistance to all current treatments is vanishingly low. So, while resistance is something to be mindful of, resistance to all medications really isn't.

First off, failure with drug resistance in an adherent person is very unlikely. Second, one wouldn't generate resistance to medication classes that you're not taking (in your case, protease inhibitors, non-nukes, CCR5 inhibitors).

If one develops resistance, the very first thing to do is to determine the pattern of resistance and available options. This should be done while still on treatment, rather then after a discontinuation, since the test won't optimally detect resistance if you're off meds.

Lastly, even in cases of multi-class drug resistance (we reported the world's first case of transmitted 4 class drug resistance), successful treatment regimens can be constructed.

I hope that this helps, BY

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