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Why people develop drug resistance>
Aug 9, 2013

Hello my favorite doctor!!! Why does people develop drug resistance? It happens to everyone on meds? How can I avoid drug resistance?

I have heard many stories about this doctor and now I am worry! I would whatever it takes to stay healthy and looking good ;) I take my meds around 7 am-7:30am everyday and 2 weeks after I started treatment (2years ago) became undetectable,I am healthy and love life, I want to know what I need to do so that doesn't happen to me.

Love u doctor!!!!!!!!!!!!! and thank you million times for your good work .

Daylet

Response from Dr. Young

Hello and thanks for posting and your nice words.

Emergence of HIV drug resistance and treatment failure used to be a frequent clinical event. Fortunately, with today's diagnostics and much improved understanding about treatments, it's much less common.

Drug resistance typically occurs in a limited set of conditions.

(1) Transmitted drug resistance is not detected- this is why since 2006, US treatment guidelines have recommended doing baseline resistance testing- before any antiretroviral treatment is taken. Resistance testing is also recommended in the event of rising viral loads (especially when above 1000) while taking medications.

(2) Suboptimal drug levels due to poor adherence. If one misses enough medication doses over a sustained period of time, HIV is allowed to grow in the presence of drug. Darwinian selection then selects for those viruses that have improved ability to grow while medications are present.

(3) Suboptimal drug levels due to other factors- this could be the result of drug-drug interactions, inappropriate dosing (ie., food restrictions) or poor manufacturing of medications (ie., counterfeit drugs). Here in the US, my greatest concern is the possible impact of drug-drug interactions (for example with stomach acid lowering medications) or dietary restrictions (some drugs must be taken with food for optimal absorption).

It's heart warming to hear that you're doing so well. In your case, the most important thing is to keep on taking your medications, twice daily (if that's what your regimen and provider recommend). If you've been successful for 2 years, the likelihood of treatment failure in the future is markedly low. Your suppression is an indication that you, your doctor and support system have got things figured out. Now comes the shift to thinking about the challenges of healthy aging and long time health with HIV.

Abrazos, BY



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