|What lies ahead?
Jan 1, 2002
I am in my mid-40s and was diagnosed in Dec 99 and have been on D4T, 3TC and Nevirapine since then. I am 99 compliant. I believe I seroconverted in 1991. Have had < 50 copies for more than a year now, 1000+ CD4s for 9 months and now 42 CD4 percentage. I am essentially healthy with no major side effects. Every time I have a blood test, though, I get very anxious and wonder if it will be the time when resistance will have developed. When I was initially diagnosed an HIV specialist told me he thought I'd have 2 years without trouble but after that I'd need to change drugs. My HIV GP told me that he thought resistance was inevitable. But another HIV specialist tells me it's not known if resistance is inevitable. I try to enjoy life and live for the here and now while still pursuing career goals and working hard but I wonder whether there's a downturn around the corner. I particularly worry about lipodistrophy and lipoatrophy as I fear these would prejudice my career prospects. One doctor told me that these were the 'invariable result of most treatments'. What can I reasonably expect and not expect? I'd like to have a realistic outlook on the future. I appreciate that you may not be able to predict in my individual case, but I'd like to know something of the general patterns that are emerging in the post-HAART era for those for whom treatment works. Thank you for any advice you may be able to offer.
Response from Dr. Little
It is true that many people will fail the first therapy that they start - hence the suggestion by some providers that it is to be anticipated that another regimen will be needed in the future. However, strictly speaking, I do not believe that we have any data to suggest that the regimen you are on (or any other fully suppressive regimen) will fail after a defined period. In fact, the best evidence suggests that as long as the viral load remains less than 50 and you maintain 100% compliance, you should do quite well. The regimen you are on is quite potent, but has what we consider a "low threshold" for resistance. What this means is that missing a few doses can result in the opportunity for the virus to develop resistance. This does not mean that this is a bad regimen - only that it is best restricted to those who rarely if ever miss doses. If you can maintain the schedule you are on, you should do quite well indefinitely with these medications. The entire pharmaceutical industry is working hard with the scientific community to try and develop better, more potent drugs in the near future with fewer associated side effects.
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